Clinical management system for chronic illnesses using telecommunication

ABSTRACT

Patients with chronic illnesses resist using conventional automated healthcare management systems to supply necessary clinical data because such systems feel impersonal, preferring to actually visit a clinic where the patient interacts with various healthcare practitioners. In this invention, the patient interacts with a clinical management system via a series of initial GUI screens that replicate the experience of actually visiting the clinic. Additional screens allow the patient to submit clinical information, to communicate with that patient&#39;s healthcare practitioner and other healthcare practitioners, to access management information that aids the patient in managing that patient&#39;s chronic illness, and to access educational information regarding that chronic illness. The clinical management system may be used to manage a plurality of different chronic illnesses while providing a consistent look and feel to the screens. At least one appearance characteristic can be altered to indicate the particular chronic illness to which a screen applies.

CROSS-REFERENCE TO RELATED APPLICATION

The present application is a divisional of and claims the benefit ofU.S. patent application Ser. No. 09/967,923, filed Oct. 2, 2001, theentire disclosure of which is incorporated by reference herein.

STATEMENT OF GOVERNMENT SUPPORT

This invention was made with U.S. Government support under Grant NumberNOI-LM6-3544 awarded by the National Institutes of Health and GrantNumber DAMDI7-94-V-4015 awarded by the Department of Defense. The U.S.Government has certain rights in the invention.

BACKGROUND OF THE INVENTION

1. Field of Invention

The invention generally relates to using a distributed network toclinically manage chronic illnesses.

2. Description of Related Art

Managing chronic illnesses is both costly and difficult. Both patientsand healthcare practitioners wish to decrease costs and inconvenience byreducing unnecessary clinic visits. However, the management quality of achronic illness increases with the frequency that the clinical dataobtained from the patient is updated. Automated and manual medicaldevices may be operated by a patient to provide the updated clinicaldata. However, the patient can operate the device improperly or haslittle opportunity to supply the clinical data to the healthcarepractitioner.

For example, U.S. Pat. No. 6,039,688 to Douglas et al. describes atherapeutic behavior modification program, compliance monitoring andfeedback system. This system provides a series of milestones forpatients to achieve to maintain good health. Patients may access thesystem over the Internet to review compliance data and to receivemotivation. This system is designed around a community support motifthat allows the patient to access various graphic representations of acommunity to access different parts of the system.

SUMMARY OF THE INVENTION

However, patients with chronic illnesses often resist using such systemsas that described in the 688 patent because such systems often feelimpersonal. Patients also often fail to supply the clinical data throughthe conventional automated and manual medical devices, again due to theimpersonal nature of the systems used to supply such data to thehealthcare practitioner. Thus, while such systems provide the ability tomanage a chronic illness using a distributed network to supply thenecessary clinical data from the patient to the healthcare practitionerand to communicate information to and from the patient, patients withchronic illnesses often tend to avoid using such systems.

Rather, patients with chronic illnesses often strongly tend to preferactually visiting a clinic dedicated to managing the healthcare ofpatients with such chronic illnesses. At such actual clinic visits, thepatient interacts with various nurses and other healthcare managementstaff members and, most importantly, with a personal healthcarepractitioner with whom the patient has developed a relationship.However, such actual clinic visits are expensive for healthcare insurersand are burdensome for patients with chronic illnesses to make at theneeded frequency.

This invention provides systems and methods that provide a graphicaluser interface-based clinical management that simulates an actual visitto a physical clinic directed to managing a chronic illness.

This invention separately provides systems and methods that increasepatient compliance by replicating the experience of the patient visitingan actual clinic directed to managing a chronic illness.

In various exemplary embodiments of the systems and methods according tothis invention, the patient interacts with the clinical managementsystem via a series of graphical user interface screens accessed over adistributed network. Various initial graphical user interface screensreplicate the experience of actually visiting a clinic directed to aparticular chronic illness. Additional graphical user interface screensallow the patient having a chronic illness to submit updated clinicalinformation to the clinical management system. Various other graphicaluser interface screens allow the patient having a chronic illness tocommunicate with that patient's personal healthcare practitioner as wellas various staff members of the clinic that are involved with thatpatient in managing that patient's chronic illness. Various othergraphical user interface screens provide management information to thepatient usable to aid the patient in managing that patient's chronicillness, such as warnings, information and care reminders.

Still other various exemplary graphical user interface screens allow apatient having a chronic illness to access current and archivedinformation regarding that chronic illness, such as new findings,management advice and the like.

In various exemplary embodiments, the clinical management system may beused to manage a plurality of different chronic illnesses. As is wellknown in the art, patients having one chronic illness often develop oneor more additional chronic illnesses. In this case, the patient havingmultiple chronic illnesses can use a single clinical management systemto manage all of that patient's chronic illnesses using a consistentmetaphor for the various chronic illnesses. In various exemplaryembodiments, while different specific information may be provideddepending on the type of chronic illness, the information is providedusing a consistent look and feel to the graphical user interfacescreens. However, to distinguish between different types of chronicillnesses, in various exemplary embodiments, when dealing with aparticular chronic illness, the graphical user interfaces have at leastone appearance characteristic that is modified to visually indicate theparticular chronic illness to which that screen currently applies. Forexample, in various exemplary embodiments, the appearance of thegraphical user interface screens can be color coded depending on theparticular chronic illness.

In various exemplary embodiments, to allow a patient who has multiplechronic illnesses to easily determine which chronic illness is beingmanaged, an elevator metaphor is used that replicates the organizationof an actual clinic into separate floors for each different chronicillness.

These and other features and advantages of this invention are describedin, or are apparent from, the following detailed description of variousexemplary embodiments of the systems and methods according to thisinvention.

BRIEF DESCRIPTION OF THE DRAWINGS

Various exemplary embodiments of this invention will be described indetail, with reference to the following figures, wherein:

FIG. 1 is a block diagram of one exemplary embodiment of a chronicillness management system according to this invention;

FIG. 2 is a block diagram showing in greater detail one exemplaryembodiment of the clinic system of the chronic illness management systemof FIG. 1;

FIG. 3 shows one exemplary embodiment of a screen of a graphical userinterface showing a virtual clinic according to this invention;

FIG. 4 shows one exemplary embodiment of a screen of a graphical userinterface representing a lobby of the virtual clinic of FIG. 3;

FIG. 5 shows one exemplary embodiment of a screen of a graphical userinterface representing an open door to a public library of the virtualclinic of FIG. 3;

FIG. 6 shows various exemplary embodiments of portions of a graphicaluser interface screen representing bulletin board notices according tothis invention;

FIG. 7 shows one exemplary embodiment of a screen of a graphical userinterface representing a clipboard of the lobby of FIG. 4;

FIG. 8 shows one exemplary embodiment of a screen of a graphical userinterface representing an elevator metaphor according to this invention;

FIG. 9 shows one exemplary embodiment of a screen of a graphical userinterface representing an opened elevator door showing a virtual clinicfor a specific chronic illness according to this invention;

FIG. 10 shows a first exemplary embodiment of a main patient data screenof a graphical user interface according to this invention for a patienthaving diabetes;

FIG. 11 shows one exemplary embodiment of an on-screen contextuallyrelevant message displayed over information displayed on the mainpatient data screen of FIG. 10;

FIG. 12 shows one exemplary embodiment of an update patient informationform screen according to this invention;

FIG. 13 shows one exemplary embodiment of a screen of a graphical userinterface usable to access an educational article according to thisinvention;

FIG. 14 shows one exemplary embodiment of a screen of a graphical userinterface usable to display a tabular representation of hypoglycemicand/or hyperglycemic events according to this invention;

FIG. 15 shows one exemplary embodiment of a patient supplied data screenof a graphical user interface usable to display a blood sugar logaccording to this invention;

FIG. 16 shows one exemplary embodiment of a screen of a graphical userinterface usable to display a date selection graphic according to thisinvention;

FIG. 17 shows one exemplary embodiment of a screen of a graphical userinterface usable to display a linear graph according to this invention;

FIG. 18 shows one exemplary embodiment of a screen of a graphical userinterface usable to display histograms according to this invention;

FIG. 19 shows one exemplary embodiment of a screen of a graphical userinterface usable to display a pie chart according to this invention;

FIG. 20 shows one exemplary embodiment of a screen of a graphical userinterface usable to display multiple pie charts according to thisinvention;

FIG. 21 shows one exemplary embodiment of a screen of a graphical userinterface usable to display a table of laboratory results according tothis invention;

FIG. 22 shows one exemplary embodiment of a screen of a graphical userinterface usable to display medication tables according to thisinvention;

FIG. 23 shows one exemplary embodiment of a screen of a graphical userinterface usable to display a data entry table for medication accordingto this invention;

FIG. 24 shows one exemplary embodiment of a screen of a graphical userinterface usable to display an exercise log according to this invention;

FIG. 25 shows one exemplary embodiment of a screen of a graphical userinterface usable to display a blood pressure log according to thisinvention;

FIG. 26 shows one exemplary embodiment of a sere-en of a graphical userinterface displaying a tabular data summary and patient and healthcarepractitioner comments according to this invention;

FIG. 27 shows one exemplary embodiment of a screen of a graphical userinterface usable to enter patient comments into a tabular summaryaccording to this invention;

FIG. 28 shows one exemplary embodiment of a screen of a graphical userinterface displaying a date selection graphic according to thisinvention;

FIG. 29 shows one exemplary embodiment of a screen of a graphical userinterface displaying educational information according to thisinvention;

FIG. 30 shows one exemplary embodiment of a screen of a graphical userinterface displaying a particular educational information according tothis invention;

FIG. 31 shows one exemplary embodiment of a screen of a graphical userinterface displaying a contacts page according to this invention,

FIG. 32 shows a second exemplary embodiment of the main patient datascreen of the graphical user interface according to this invention for apatient having a chronic kidney illness;

FIG. 33 shows the main patient data screen of FIG. 30 displaying anothereducational article according to this invention;

FIG. 34 shows a second exemplary embodiment of the patient supplied datascreen of the graphical user interface according to this inventiondisplaying an automated cycler flow sheet;

FIG. 35 shows a second exemplary embodiment of the screen of a graphicaluser interface usable to display linear graphs according to thisinvention;

FIG. 36 shows a second exemplary embodiment of the screen of thegraphical user interface usable to display a table of laboratory resultsaccording to this invention;

FIG. 37 shows a second exemplary embodiment of the screen of thegraphical user interface usable to display medication tables accordingto this invention;

FIG. 38 shows a second exemplary embodiment of the screen of thegraphical user interface displaying an educational page according tothis invention for patients having a chronic kidney illness;

FIG. 39 shows one exemplary embodiment of a screen of a graphical userinterface usable to display recipes available to patients according tothis invention;

FIG. 40 shows the graphical user interface screen of FIG. 34 displayingan educational article on kidney disease;

FIGS. 41A-B show the graphical user interface of FIG. 34 displaying aneducational article about peritoneal dialysis having selectable linksaccording to this invention;

FIG. 42 shows one exemplary embodiment of a screen of a graphical userinterface displaying an abstract of an educational article for patientshaving a chronic kidney illness according to this invention;

FIGS. 43 and 44 show various exemplary embodiments of screens of agraphical user interface displaying procedure instructions to a patient;

FIGS. 45A-45C and 46A-46E show various exemplary embodiments of screensof a graphical user interface usable to display specific procedureinstruction and troubleshooting information for performing the procedureillustrated in FIGS. 43 and 44;

FIGS. 47A-47I show one exemplary embodiment of a screen of a graphicaluser interface usable to display daily routine information forperitoneal dialysis patients according to this invention;

FIG. 48 shows another exemplary embodiment of a screen of the graphicaluser interface according to this invention usable to display on-screencontextually relevant messages;

FIG. 49 shows one exemplary embodiment of a screen of a graphical userinterface that enables access to the patient's healthcare practitionersover a distributed network according to this invention;

FIG. 50 shows one exemplary embodiment of a screen of a graphical userinterface usable by a healthcare practitioner to access a patient'shealthcare records according to this invention,

FIGS. 51A and 51B show various exemplary embodiments of a practitionerscreen of a graphical user interface usable to display various exemplaryembodiments of alerts, messages and reminders according to thisinvention;

FIGS. 52, 54 and 55 show various exemplary embodiments of screens of agraphical user interface displaying medication tables to a practitioneraccording to this invention;

FIG. 53 shows one exemplary embodiment of a screen of a graphical userinterface displaying insulin pump information to a practitioneraccording to this invention;

FIG. 56 shows one exemplary embodiment of a screen of a graphical userinterface displaying tabular data summary and healthcare practitionercomments to a patient according to this invention;

FIG. 57 shows one exemplary embodiment of a screen of a graphical userinterface usable to add a new patient or practitioner according to thisinvention;

FIG. 58 shows one exemplary embodiment of a screen of a graphical userinterface usable to submit practitioner registration information;

FIG. 59 shows one exemplary embodiment of a screen of a graphical userinterface usable to submit patient registration information according tothis invention;

FIGS. 60-62 show various exemplary embodiments of the screens of agraphical user interface usable to submit patient lab data according tothis invention;

FIGS. 63-65 show various exemplary embodiments of screens of a graphicaluser interface usable to input patient reminder information according tothis invention;

FIG. 66 shows one exemplary embodiment of a main visitor data screen ofa graphical user interface according to this invention;

FIGS. 67A-67G show one exemplary embodiment of a screen of a graphicaluser interface displaying project description information according tothis invention;

FIG. 68 shows one exemplary embodiment of a patient message list screenof a graphical user interface according to this invention;

FIG. 69 shows one exemplary embodiment of a patient message list screenof a graphical user interface according to this invention;

FIG. 70 shows one exemplary embodiment of a screen of a graphical userinterface usable to add a message according to this invention;

FIG. 71 shows one exemplary embodiment of a healthcare practitionermessage list screen of a graphical user interface according to thisinvention;

FIG. 72 shows one exemplary embodiment of a healthcare practitionermessage list window of a graphical user interface according to thisinvention;

FIG. 73 shows a first exemplary embodiment of a healthcare practitionermessage list screen of a graphical user interface according to thisinvention after a patient has been selected by a healthcarepractitioner, and

FIG. 74 shows one exemplary embodiment of a healthcare practitionermessage list window of a graphical user interface according to thisinvention after a patient has been selected by a healthcarepractitioner.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

FIG. 1 shows one exemplary embodiment of a chronic illness managementsystem 100 that is usable to manage one or more chronic illnesses. Asshown in FIG. 1, the chronic illness management system 100 according tothis invention includes one or more healthcare practitioner dataterminals 130, one or more patient data terminals 120, and zero, one ormore visitor data terminals 140, that are connected by a network 110 toa clinic system 200 that implements a virtual clinic. The network 110may be a local area network (LAN), a wide area network (WAN), theInternet, an intranet, an extranet, or any other known orlater-developed type of distributed network 110 usable to connectpatients, healthcare practitioners and/or visitors to the clinic system200.

Thus, the chronic illness management system 100 connects patients,healthcare practitioners and/or visitors to the virtual clinic over adistributed network. Access and privileges of the chronic illnessmanagement system 100 are determined by a user's status as a patient, ahealthcare practitioner, or a visitor. Patient users may providequantitative clinical data, based on the operation of a medical device122, and/or comments to their healthcare practitioner over one of theone or more patient data terminals 120. The chronic illness managementsystem 100 uses the network 110 to connect patients having one or morechronic illnesses, healthcare practitioners of various occupations, forexample, specialized healthcare practitioners. primary care healthcarepractitioners, nurses, and the like, and visitors to the clinic system200.

In various exemplary embodiments, each patient data terminal 120, eachhealthcare practitioner data terminal 130, and/or each visitor dataterminal 140 can be implemented using standard personal computers,laptop computers, handheld computers, and/or personal digitalassistants, or the like, having one or more of a network interface, adata display device, such as a video monitor, one or more input devices,such as a keyboard and/or a mouse, and a network browser softwareprogram, or any other known or later-developed hardware elements, anyother known or later-developed software components, or any known orlater-developed combination of such hardware components and softwarecomponents that may provide equivalent functionality. Each patient dataterminal 120 may also have an input/output interface to which themedical device 122 can be connected to allow clinical data to bedirectly downloaded from the medical device 122 and sent over thenetwork 110 to the clinic system 200.

FIG. 2 shows in greater detail one exemplary embodiment of the clinicsystem 200 of FIG. 1. In the exemplary embodiment of the system 200shown in FIG. 2, the clinic system 200 shows a network interface 210, an(optional) firewall 212, a memory 230, a controller 220, a control/databus 240 and a database 232 that stores at least some of the informationdescribed below. The network interface 210 can, in various exemplaryembodiments, provide system security by encrypting and transmittingthrough a secure portion by using, for example, hypertext transferprotocol secure (HTTPS) running over a secure socket layer (SSL) or byany other known or later-developed security mechanism. The optionalfirewall 212, if implemented, uses a combination of hardware elementsand/or software components that moderates the communication of theclinic system 200 with systems external to the clinic system 200 andvice versa. The optional firewall 212, if implemented. uses, forexample, an external proxy server that decides whether communicationsare safe to pass through to the clinic system 200.

In general, the memory 230 can include one or more of random accessmemory, read only memory, hard disks, writeable optical disks, flashmemory or the like. In general, the controller 220 receives data fromand generates instructions to the other components of the clinic system200, and reads, writes and processes data. The database 232 stores atleast information concerning patients and healthcare practitioners,clinical data received from patients, laboratory test results,information concerning medications that will be or have been prescribedto and/or used by one or more patients, educational information, andgeneral information concerning the chronic illness management system100.

It should he appreciated that the following discussion is generallyequally directed to standard windowed graphical user interfaces andgraphical user interfaces using web-based implementations, where eachgraphical user interface “screen” is a distinct web page written inHTML, XML or any other known or later-developed web page authoringlanguage. As a result, in various exemplary embodiments, the selectableicons of the following description are implemented as hypertext links torelated web pages or to distinct regions of a current web page. However,it should be appreciated that any other known or later-developedgraphical user interface implementation technique could be used toimplement the graphical user interface screens and/or graphical userinterface elements described herein.

Thus, it should also be appreciated that this graphical user interfacecan be implemented as a Windows-based system, rather than as a web-basedsystem. In this case, the graphical user interface screens are distinctportions of the graphical user interface that is accessed by specificWindows events that are associated with particular selectable icons orother interactive elements or widgets. As a result, the selectable iconsand other interactive elements of these graphical user interface screenscan be implemented as Windows widgets or the like.

It should also be appreciated that, in the following discussion of thegraphical user interfaces and screens according to this invention,selecting a selectable icon or other interactive element can includeactivating any feature of the graphical user interface that generates anew screen or allows the patient to enter data, for example, by using adrop-down list box, a dialog box, an option button, or the like. Anon-screen indicator usable to select a feature of the graphical userinterface may be, for example, a mouse pointer, a cursor, or any otherknown or later-developed on-screen indicator used in conjunction with,for example, a mouse, a touch pad, a touch screen, a light pen, ajoystick, a trackball or any other known or later-developed on-screenlocation input device.

As shown in FIG. 3, when a patient or a visitor logs onto the chronicillness management system 100 from one of the data terminals 120, 130 or140 via the network 110, the clinic system 200 presents a graphical userinterface screen 300 having a graphic representation of a clinic 304 ofthe outside of a clinic building. In some exemplary embodiments, thisgraphic representation of the clinic 304 shows, for example, an entrancedoor 302 to the clinic, and one of mote of a name of the clinic or thebuilding, reflections of the sky in the clinic windows, surroundingwalkways and flowerbeds, and a name of the clinic program to which thepatient belongs. This graphic representation of the clinic 304 providesthe patient with a feeling that the patient is effectively visiting anactual clinic, which is both familiar and assuring.

In various exemplary embodiments, the graphic representation of theclinic 304 further elicits a feeling of timeliness by changing aspectsof the graphic representation of the clinic 304 to reflect the time ofday and time of year when the patient logs onto the system. For example,if the patient logs on during a summer day, the graphic representationof the clinic 304 shown in FIG. 3 shows the clinic during a summer daywith blue skies reflected in the clinic windows and blossomingflowerbeds outside the clinic entrance. Other graphic representations ofthe clinic 304 are automatically displayed on the screen correspondingto the different seasons and time of day. For example, a graphicrepresentation for a winter day may show blue skies reflected in theclinic windows, snow piled on the flowerbeds and ledges of the clinic,and snowflakes drifting down from the sky. The graphic representation ofthe clinic 304 for both summer and winter nights may, for example, showdarkened clinic windows that reflect night skies and stars. Aspects ofthe graphic representation of the clinic 304 can be altered based onholidays and/or other calendar events.

The graphic representation of the clinic 304 shown in FIG. 3 is part ofa graphical user interface that allows the patient and others to accessvarious screens of the chronic illness management that generally mimicactivities that could normally have been pursued during an actual visitby the patient to the clinic. Various clinical data and informationelements can also be displayed to the patient using these graphical userinterface screens. When the patient selects the entrance door icon 302of the graphic representation of the clinic 304 shown in FIG. 3, invarious exemplary embodiments, the entrance door icon 302 opens usinganimation. In any case, a graphical user interface screen 400, as shownin FIG. 4, of the graphical user interface is displayed in place of thescreen 300.

FIG. 4 shows one exemplary embodiment of the graphical user interfacescreen 400. The screen 400 includes a graphic representation of a cliniclobby 402. When used, the animated graphic representation of opening theentrance door icon 302 to enter the clinic lobby 402 invokes the feelingof an actual clinic visit. By mimicking an actual clinic visit, thepatient's familiarity with the clinical monitoring program can beenhanced, as can be the patient's compliance with the monitoringprogram. As shown in FIG. 4, the graphical representation of the cliniclobby 402 includes, for example, furniture and rugs, a smilingreceptionist standing behind a counter, a sign-in clipboard icon 408located on a counter 407. a door icon 404 leading to a public accesslibrary area, and a bulletin board icon 410 usable to access a bulletinboard system. Again, the graphic representation of the clinic lobby 402shows a scene that the patient would expect to encounter during anactual clinic visit.

In various exemplary embodiments, when the clipboard icon 408 isinitially indicated, such as by hovering the cursor over the clipboard408, (or is initially selected), the clipboard icon 408 rises byanimation above the counter 407. This rising of the clipboard icon 408invites the patient to sign into the clinic, just as the patient woulddo in an actual clinic visit. In response to the user selecting theraised clipboard icon 408, a graphical user interface screen 500, asshown in FIG. 7, is displayed in place of the graphical user interfacescreen 400.

When the door icon 404 to the public access library area of the cliniclobby 402 of FIG. 4 is selected, the door icon 404 opens by animation tothe position shown in FIG. 5. This open door icon 405 invites not onlypatients. but other visitors who have accessed the chronic illnessmanagement system 100 to access public information about the chronicillness management system 100.

The bulletin board 410 of FIG. 4 displays various monthly notice icons420 that may be characterized by graphic designs corresponding to therespective content of the notice. For example, one type of notice may bea holiday notice that contains a graphic design corresponding to therespective holiday for the current month. For example, as shown in FIG.6, a January holiday notice 421 may display a party hat, while the othergraphics 422-425 for the holiday notices may be displayed during theappropriate month. Other graphic designs may readily correspond to otherholidays or events. Selecting a different bulletin board notice icon 412of the bulletin board 410 shown in FIG. 4 may provide access toeducational information on chronic illnesses managed by the clinicsystem 200. This information may be provided, for example, by links toother network sites, such as Internet sites or worldwide web sites thatprovide educational information about particular chronic illnesses. Forexample, during January, a link to the website of the American DiabetesAssociation may warn diabetics to watch for freezing of theirextremities.

The bulletin board icon 410 shown in FIG. 4 also displays a news itemicon 412 concerning chronic illnesses managed by the clinic system 200.When the news item icon 412 is selected, the graphical user interfacescreen 1100, as shown in FIG. 13, is displayed in place of the graphicaluser interface screen 400.

As shown in FIG. 7, the graphical user interface screen 500 includes agraphic representation of a clipboard 502. The patient enters thepatient's name or a username and a password into the clipboard 502, forexample, by using a pair of data entry input boxes 504 and 506. Data isentered into these data entry boxes 504 and 506 by the patient using thekeyboard or other data entry device of the patient's data terminal 120.Access to other screens of the clinic system 200, which would otherwisebe open to an authorized patient, would be denied to a patient or otherperson who lacks an authorized password. The patient may change anauthorized password by selecting the change password icon or hypertextlink 508 shown on the clipboard 502 in FIG. 7.

The graphical user interface screen 500 shown in FIG. 7, and variousother data entry screens displayed by the clinic system 200, frequentlyshow two buttons: a submit button 510 and a reset button 512. The submitbutton 510, when selected, sends the data entered by the user, such asthe patients name and password entered into the data entry boxes 504 and506 to the clinic system 200. The reset button 512 allows the patient toreset the data in the data entry boxes 504 and 506 when an error ismade. Of course, it should be appreciated that the submit and resetfunctions associated with the submit and reset buttons 510 and 512,respectively, may also be implemented by enabling the enter andbackspace keys of a keyboard. It should also be appreciated that dataentry in the various screens of the chronic illness management system100 described herein is not limited to buttons, but may also include,for example, dropdown list boxes, data entry input boxes, dialog boxesand the like, and/or commercial voice recognition software programs thatrecognize data entry commands and entered data.

Once the patient has gained authorized access to the clinic system 200,the clinic system 200 recognizes that patient's chronic illness from itspatient records stored in the database 232. However, the clinic system200 may be used to manage more than one chronic illness of a patient. Asshown in FIG. 8, in various exemplary embodiments, when such a patient,for example, a patient suffering from both diabetes and kidney disease,signs into the clinic on the clipboard 502 shown in FIG. 7, thegraphical user interface screen 500 is automatically replaced with thegraphical user interface screen 600, as shown in FIG. 8. In variousexemplary embodiments, the screen 600 includes a graphic representationof an elevator 602 having a control panel 610. By selecting, forexample, the second floor elevator button icon 612, which is labeled “MyKidney Team”, the patient signals that patient's intention to visit thekidney disease clinic portion of the clinic system 200. Similarly, byselecting the third floor elevator button icon 614, labeled “My DiabetesTeam”, the patient signals that patient's intention to visit thediabetes clinic portion of the clinic system 200.

As shown in FIG. 9, in various exemplary embodiments, in response to theuser indicating or activating the second floor elevator button 612, suchas, for example, by putting the cursor over the second floor elevatorbutton icon 612, an animation of the elevator door 620 opening onto agraphical representation of the kidney disease clinic 630 is displayed.Once the elevator door 620 is shown in the fully open position and theuser selects the second floor elevator button icon 612, the screen 600is replaced with the particular exemplary embodiment of a main patientdata screen that is appropriate for the kidney clinic portion of thechronic illness management system, i.e., the kidney clinic main patientdata screen 3200, as shown in FIG. 32. Similarly, in various exemplaryembodiments, in response to the user indicating or activating the thirdfloor elevator button 614, such, for example, by putting the cursor overthe elevator button icon 614, an animation of the elevator door 620opening onto a graphical representation of the diabetes clinic isdisplayed. Again, once the elevator door 620 is shown in the fully openposition and the user selects the third floor elevator button icon 614,the screen 600 is replaced with the graphical user interface screen 700,as shown in FIG. 10. It should be appreciated that the number of clinicsand the number of clinic floors accessed by the elevator 602 will dependupon the number of distinct chronic illnesses managed by the chronicillness management system 100.

Alternatively, the animation of the elevator door 620 opening can occurin response to the user selecting one of the elevator floor button icons612-616. In this case, after the elevator door 620 reaches the fullyopen state, the screen 600 is immediately replaced with the screen ofthe graphical user interface that is associated with the selectedelevator floor button 612-616.

The patient suffering from multiple chronic illnesses may also return tothe clinic lobby 402 after visiting a particular clinic by selecting thelobby elevator button icon 616. In response to the user indicating oractivating the lobby floor elevator floor button icon 616, such as. forexample, by putting the cursor over the lobby elevator button icon 616,the elevator door 620 is, in various exemplary embodiments, animated toshow the elevator 602 opening onto the graphical representation of theclinic lobby floor. After the elevator door 620 opens onto a graphicaldepiction of the clinic lobby floor and the user selects the lobby floorelevator button icon 616, the screen 600 is automatically replaced withthe screen 400 shown in FIG. 4. This graphical representation ofelevator movement between floors to reach various clinics again mimicsthe experience the patient would expect to undergo during an actualclinic visit.

As shown in FIG. 10, after an authorized patient signs into the clinicsystem 200 using the screen 500, and depending on whether the elevatorparadigm underlying the screen 600 is used to select a particular clinicfor one of a number of chronic illnesses experienced by the patient, thescreen 500 or the screen 600 is replaced with a main patient data screen700. In the particular exemplary embodiment shown in FIG. 10, a patientsuffering from diabetes has accessed the main patient data screen 700.Thus, the particular content of the main patient data screen 700 shownin FIG. 7 is that for a patient suffering from diabetes.

Of course, it should be appreciated that the particular contents of themain patient data screen 700 will depend on the particular chronicillness that the patient who has accessed the main data screen 700 issuffering from and may also depend upon whether the patient has used theelevator control panel 610 to select from multiple chronic illnesses.However, it should be appreciated that, in various exemplary embodimentsof the chronic illness management system 100 according to thisinvention, the various main patient data screens, such as the screens700 and 3200, maintain a consistent look and feel for the various icons,data portions and other elements, other than disease-specific data.between the various chronic illnesses that may be managed using thechronic illness management system 100.

In particular, it should be appreciated that the main patient datascreen, such as the screens 700 and 3200, is the initial screen shown topatients after the patients sign into any one of the one or moredifferent disease-specific clinics that may be implemented in thechronic illness management system 100. In various exemplary embodiments,to maintain the consistent look and feel between such different chronicillness clinics, the main patient data screen 700 includes, for example,a frame 800 and a central display area 710. To maintain the consistenttook and feel of the main patient data screen 700, the frame 800 and thecentral display area 710 are maintained in consistent locations, shapesand relative proportions. In various exemplary embodiments; the frame800 is displayed above and to the left of the central display area 710.However, it should be appreciated that the frame 800 can be positionedin any desired location within the main patient data screen 700.

However, because a consistent look and feel for the main patient datascreen is maintained regardless of the particular chronic illness clinicthat is being accessed, it is possible that a patient suffering frommultiple chronic illnesses could have difficulty remembering whichparticular chronic illness is currently being accessed. Accordingly, invarious exemplary embodiments, to help identify which particular chronicillness clinic is being accessed through the main patient data screen,such as the screens 700 or 3200, the background 810 of the frame 800 orof a frame 3202 of the screen 3200, can be color coded based on theparticular chronic illness clinic that the user is visiting using themain patient data screen 700. For example, the background 810 for thediabetes clinic main data screen 700 could be blue, while the background810 for the frame 3202 of the kidney disease clinic main data screen3200 could be green. Thus, any graphical user interface screen having aframe 800 having a blue background 810 has been accessed through thediabetes clinic portion of the clinic system 200 and/or is displayingdiabetes-related data, clinical information, and/or educationalinformation.

In various exemplary embodiments, the frame 800 may include, forexample, a selectable icon or hypertext link 820 displaying the user'sname, a date indicator 822, a selectable icon or hypertext link 824 thatis linked to another screen of the graphical user interface, and aselectable icon or hypertext link 826 that is linked to a website for asponsor of the clinic system 200, such as a university that isassociated with the virtual clinic. In various exemplary embodiments,the frame 800 may also include, for example, a selectable messages iconor hypertext link 832, a selectable clinical data icon or hypertext link834, a selectable education icon or hypertext link 836, a selectablecontact icon or hypertext link 838 and/or a selectable logout icon orhypertext link 840. Each of the selectable icons or hypertext links832-840 is usable to change the information displayed in the centraldisplay area 710 of the main patient data screen 700.

As indicated above, each of the elements 832-840 can be a selectableicon or a hypertext link. To simplify the following detaileddescription, the term icon will be used interchangeably with the termsselectable icon and hypertext link.

In response to selecting the messages icon 832 of the frame 800, amessages screen 900 is displayed in the central display area 710 of themain patient data screen 700. In contrast, selecting the clinical dataicon 834 causes various types of clinical information and clinical datato be presented to the patient in the central display area 710 of themain patient data screen 700 using the screens 1500-2100 and 6800. Inresponse to selecting the education icon 836, the diabetes educationscreen 2200 shown in FIG. 29 is displayed in the central display area710 of the main patient data screen 700.

Selecting the contact icon 838 causes one of a number of contact screensto be displayed, such as the diabetes contact screen 2400 shown in FIG.31 or a contact screen for the kidney clinic. It should be appreciatedthat the particular contact screen accessed using the contact icon 838will depend on a particular chronic illness clinic that the patient iscurrently visiting. Finally, selecting the logout icon 840 logs thepatient out of the currently selected chronic illness clinic anddisplays the clinic lobby screen 400 or the elevator screen 600,depending on whether the patient has one or more chronic illnesses, inplace of the main patient data screen 700.

As shown in FIG. 10, in various exemplary embodiments, when the mainpatient data screen 700 is first displayed during any given session, themessages screen 900 is also automatically displayed in the centraldisplay area 710. The messages screen 900 includes a patient greeting910, appropriately addressed and based on the time of day (i.e., “GoodMorning,” “Good Afternoon,” or “Good Evening”) followed by the patient'sname, a selectable icon or hypertext link 920 to a screen that displaysthe latest news, a dropdown list 930 that allows the patient to accessarchived news items on various subjects, and alerts portion 940, amessages portion 950 and a reminders portion 960.

In various exemplary embodiments, the information presented to thepatient concerning the alert portions 940, the messages portion 950and/or the reminders portion 960 of the messages screen 900 isautomatically extracted or derived from the data stored in therelational database 232 when the patient initially accesses the mainpatient data screen 700 by analyzing the data stored in the relationaldatabase 232 in real time. The information presented to the patient inthe alerts portion 940, the messages 950 and/or the reminders portion960 of the message screen 900 is the type of information that ahealthcare practitioner or other healthcare practitioner would emphasizeto a patient during an actual clinic visit.

When the amount of information to be displayed in any one of the alertsportion 940, the messages portion 950 or the reminders portion 960, orin total in the messages screen 900, exceeds the size of the centraldisplay area 710, a vertical and/or horizontal scroll bar (not shown),as is well known in the art, can be implemented to allow the patient toview any information that could not initially be displayed in thecentral display area 710. Of course, it should be appreciated that thistechnique will be usable for all of the following screens that can bedisplayed in the central display area 710. Thus, use of scroll bars willnot be further described.

As shown in FIG. 10, the alerts portion 940, the messages portion 950and/or the reminders portion 960 of the messages screen 900 may containmedical terms that have embedded hypertext links or graphical userinterface widgets, such as the hypertext link or graphical userinterface widget 954 shown in FIG. 10. These hypertext links orgraphical user interface widgets allow the patient to access additionalscreens, separate windows, and/or windows elements of the graphical userinterface that provide information about such medical terms.

Thus, as shown in FIG. 11, when the patient selects or hovers over orotherwise indicates the hypertext link or graphical user interfacewidget associated with such a medical term, such as the graphical userinterface widget or hypertext link 954 associated with the medical term“HbAIC” in FIG. 10, contextually relevant information 1000 may bedisplayed, for example, in a pop-up dialog box 1000. The informationcontained within the pop-up dialog box 1000 defines and/or furtherexplains the medical term, symbol or icon associated with the selectedor indicated hypertext link or graphical user interface widget.Alternatively, rather than using the pop-up dialog box 1000, selectingand/or indicating the hypertext link or graphical user interface widgetcould result in a glossary screen (not shown) being displayed.

As shown in FIG. 11, in various exemplary embodiments that use thepop-up dialog box 1000, selecting or indicating the graphical userinterface widget or hypertext link 954 associated with the medical term“HbAlC” in the messages portion 950 results in the pop-up dialog box1000 being displayed and containing a contextually relevant messageproviding a definition for this medical term. Similarly, in variousexemplary embodiments, hovering over or indicating, but not selecting,the education icon 836 of FIG. 10 also causes a contextually relevantmessage (not shown) to be displayed that may further characterize theeducation icon 836 as “a diabetes educational site”.

The messages portion 950 can also optionally include a hypertext link orgraphical user interface widget (not shown) that allows a patient toprovide comments when the patient has entered new clinical data, such asblood glucose values, into the clinic system 200. In this case,selecting the hypertext link or graphical user interface widgetassociated with the newly entered clinical data, such as, for a diabetespatient, blood glucose levels, results, in various exemplaryembodiments, in a text entry box (not shown) being displayed to thepatient. Alternately, in various other exemplary embodiments, thisresults in the message screen 900 being replaced with a clinical datacomments screen (not shown). In either case, in response to selectingthe hypertext link or graphical user interface widget associated withthe new clinical data, the patient is able to enter comments about thenew clinical data from that patient's data terminal 120,

As shown in FIG. 12, when the patient selects the patient's name icon820 in the frame 800, the main patient data screen 700 is replaced withan update patient information screen 1200. The update patientinformation screen 1200 may include a number of data entry boxes1201-1206 usable, for example, to update the patient's personalinformation, such as the patient's name, address, telephone numbers,marital status, employment, and/or e-mail or message address. The updatepatient information screen 1200 can also include a number of data entryboxes 1210-1212 usable to update the patient's medical information, suchas the name and/or telephone number of that patient's primary carehealthcare practitioner, and/or that patient's allergies. Finally, theupdate patient information screen 1200 can include a number of dataentry boxes 1220-1223 usable to update the patient's emergencyinformation such as the name, address, relationship and/or telephonenumber of that patient's emergency contact.

As shown in FIG. 13, in response to the patient selecting the hypertextlink or graphical user interface widget 920, the messages screen 900displayed in the central data area 710 of the main patient data screen700 is replaced with a news screen 1100. The news screen 1100 displaysone or more recent news articles that are relevant to the particularchronic illness that the patient was managing at the time the hypertextlink or graphical user interface widget 920 was selected. As describedabove with respect to the messages screen 900, when the news articledisplayed in the news screen 1100 exceeds the size of the centraldisplay area 710, the entire news article may be viewed by usingvertical and/or horizontal scroll bars (not shown). Using the archivesnews dropdown list box 930 allows archival news to be selected fordisplay in the news screen 1100.

As shown in FIG. 10, the alerts portion 940 of the messages screen 900displays information to the patient that is derived from the clinicaldata supplied, or often, not supplied, by the patient to the clinicsystem 200 over the patient's data terminal 120 and the network 110. Fora diabetic patient, the information displayed in the alerts portion 940is derived from an automated, real-time analysis by the clinic system200 of the measured blood glucose values that the patient has sent tothe clinic system 200 and which has been stored in the relationaldatabase 232_ The alerts portion 940 summarizes those events, andactivities and/or inactivities, which may be detrimental to the patient.

Data is analyzed by the clinic system 200 to inform patients, using thealerts portion 940, about various clinical parameters that have reachedan indicated alert level, In the data illustrated in the exemplaryembodiment shown in FIG. 10, the latest HbAlC value is greater than thesite/patient configurable value. As a result, the value of the patient'slatest HbAlC value is printed in red and an appropriate message isattached and displayed in the alerts portion 940. Similarly, if thepatient's Average Blood Glucose value over the last 2 weeks is greaterthan the site/patient configurable value, the patient's Average BloodGlucose value is printed in red and an appropriate message is attachedand displayed in the alerts portion 940. If the number of hypoglycemicevents and/or hyperglycemic events exceeds the correspondingsite/patient configurable value, then the stored clinical data isanalyzed to show when these hypoglycemic and/or hyperglycemic eventsoccurred. As shown in FIG. 14, these hypoglycemic events and/orhyperglycemic can be organized by the day of week in the table portionor tabular chart 1410 and/or by the time of day in a table portion ortabular chart 1412 of an events screen 1400. Similarly, if more than asite/configurable time period has past since receiving new blood glucosedata, then the number of days is printed in red and a message isattached and displayed in the alerts portion 940.

Additionally, in the data illustrated in the exemplary embodiment shownin FIG. 10, data is analyzed to inform a patient about positive resultsin the patient's data in the messages portion 950. If the patient'sAverage Blood Glucose value over the previous two weeks is less thansite/patient configurable value, then that value is printed in green,with a smiley face 952 and message attached and displayed in themessages portion 950. If the patient's latest HbAlC value is less thansite/patient configurable value and has decreased by a site/patientconfigurable amount, then that value is printed in green, with a smileyface 952 and message attached and displayed in the messages portion 950.Finally, if a patient has sent new blood glucose data without attachinga comment, the patient is prompted to do so at that time by displayingan appropriate message in the messages portion 950. Of course, it shouldbe appreciated that the particular alerts and messages displayed in thealerts portion 940 and the messages portion 950 will depend on theparticular chronic illness the patient is suffering from

In the exemplary embodiment illustrated by the data shown in FIG. 10,the clinic system 200 has analyzed the blood glucose values submitted bythe patient and has determined from the clinical data and/or otherinformation stored in the relational database 232 that this patient hasnot reported blood glucose data (BO data) in 696 days. In performing itsanalysis, the clinic system 200 compares the number of days for whichblood glucose values were not reported to a threshold value. When thisthreshold value is exceeded the clinic system 200 causes an appropriatealert message to be displayed in the alerts portion 940. The number ofdays a blood glucose value has not been received may also be emphasizedto the patient by color coding the number of days, in this case 696,displayed in the alerts portion 940, depending on the urgency and/orimportance of the message.

In the exemplary embodiment illustrated by the data shown in FIG. 10,the clinic system 200 also summarizes the number of hypoglycemic andhyperglycemic events present in the information and clinical data storedin the relational database 232. The clinic system 200 causes thegenerated summary information to be displayed in the alerts portion 940as well. The clinic system 200 determines these types of events bycomparing the clinical data stored in the relational database 232 to oneor more threshold values. The threshold values have been entered intothe clinic system 200 by a healthcare practitioner via one of thehealthcare practitioner data terminals 130. Each event, or each set ofevents, is associated with a hypertext link or a graphical userinterface widget, as shown in the alerts portion 940.

When the patient selects the hypertext link or graphical user interfaceassociated with such an event listed in the alerts portion 940, themessages screen 900 displayed in the central data portion 710 isreplaced with the events screen 1400 shown in FIG. 14. As shown in FIG.14, the events screen 1400 shows various organizations of the eventsassociated with the selected hypertext link or graphical user interfacewidget. For example, when the hypertext link or graphical user interfacewidget 942 regarding hypoglycemic and/or hyperglycemic events shown inFIG. 10 is selected, the events screen 1400 shows various hypoglycemicand/or hyperglycemic events associated with that hypertext link orgraphical user interface widget organized by day of week in a firsttabular chart 1410 and by time of day in a second tabular chart 1412.

The information displayed in the messages portion 950 may also beprovided by the clinic system 200. The messages that may be displayed inthe messages portion 950 include, for example, that MAX and/or averageblood glucose are in target. The real-time analysis by the clinic system200 of the patient's blood glucose values that are stored in therelational database 232, when compared to a clinical target rangeprovides information about the number of times the patient's bloodglucose values either fall below or exceed the normal range. Based onthe number of times the patient's blood glucose values are not normal,the messages displayed in the messages portion may indicate whether thepatient is properly managing his or her diabetes. For example, goodmanagement of the patient's diabetes may be indicated by animated yellowsmiting faces 952, while poor management may be indicated by bluefrowning faces (not shown). A green blood glucose value or clinical testvalue in a message may indicate a normal value, indicating good clinicalmanagement of the diabetes. Messages are the type of information that aclinician is likely to emphasize to a patient during a clinical visit.

In FIG. 10, the patient's healthcare practitioners have enteredreminders to the patient, for medical tests, exams and visits, into theclinic system 200, These reminders are stored in the relational database232. Data is mined to determine and/or generate reminders of lab tests,clinic visits, etc. for the patient. These reminders are then displayedin the reminders portion 960. The status of the reminders, such as,whether the patient has properly responded to the reminder, can becolor-coded. In various exemplary embodiments, such as that shown inFIG. 10, a patient is prompted, at a site/patient configurable timeprior to the event, to schedule an appointment. For example, the dayspast due for an appointment to have been scheduled, or a missedappointment, may be emphasized by setting the appearance of some or allof that text string to red. In the exemplary embodiment shown in FIG.10, the number of days the appointment is past due is displayed in red.

Selecting the clinical data icon 834 when accessing the diabetes clinicchanges the information displayed in the central display area 710 to oneof a set of interlinked clinical data screens 1500-2100 and a messagelist screen 6800. In particular, in the exemplary embodiments shown inFIG. 15, the clinical data screen initially displayed upon selecting theclinical data icon 834 is a patient supplied data screen 1500. However,it should be appreciated that any of the clinical data screens 1500-2100or the messages list screen 6800 could be initially displayed.

The patient supplied data screen 1500 displays the clinical data thathas been submitted to the system by the patient using the medical device122, such as, an automated or manual blood glucose meter. For a diabeticpatient, the clinical data are the patient's blood glucose values,displayed as a blood sugar log 1510 in the patient supplied data screen1500, as shown in FIG. 15. The blood sugar log 1510 is a chart withsummary data. An explanatory legend 1512 is located beneath the chart,as shown in FIG. 15.

The patient supplied data screen 1500 also includes a tool bar 1520 thatincludes a number of icons usable to change the type of graphing used todisplay the patient supplied data and a tool bar 1501 that includes anumber of icons usable to switch between the various clinical datascreens 1500-2100 and 6800. It should be appreciated that the patientsupplied data screen 1500 can also be accessed through the icon 1503 ofthe toolbar 1501.

The blood sugar log 1510 displays blood glucose (BG) values by date andtime of day in the chart. A single row of the chart may display thedate, blood glucose values at specific time intervals during the day,the number of blood glucose values obtained in a day (# Readings), andthe average value of the blood glucose readings for the day (Avg.Reading). At the bottom of the blood sugar log 1510, the average valuesof blood glucose for a specific daily time interval and the averagenumber of readings per time frame (not shown) may be displayed.Additional rows at the bottom of the chart may display the number ofhypoglycemic events and hyperglycemic events (not shown) that occur in aspecific daily time interval for the displayed dates.

In the blood sugar log 1510, a blood glucose value having an associatedgraphical user interface widget or hypertext link may indicate that morethan one blood glucose reading was taken during a time interval. Whenmultiple blood glucose readings occur within a time interval, only thefirst blood glucose value is displayed in the chart. However, when thegraphical user interface widget or hypertext link associated with such ablood glucose value is selected, an on-screen contextual message (notshown) displays all the blood glucose values submitted during thatinterval.

Beneath the blood sugar log 1510, the average blood glucose value forall time intervals over the displayed dates is shown, along with astatistical standard deviation of all the blood glucose values and therange of blood glucose values, indicating maximum and minimum bloodglucose values (not shown). Additionally, the legend 1512 beneath theblood sugar log 1510 explains the color coding of the blood glucosevalues in the chart, which may represent hypoglycemic values in blue,hyperglycemic values in red, and normal blood glucose values in greenHypoglycemic and hyperglycemic values may, alternatively, be displayedwith an associated minus sign or plus sign, respectively.

In particular, in various exemplary embodiments of the systems andmethods according to this invention, the values in the log book arecolor coded and/or are preceded by a + sign or a − sign, depending ontheir value. If the values in the log book arc greater than asite/patient configurable value, then the values are displayed in redand preceded by a +. If the values in the log book are less than asite/patient configurable value, the values are displayed in blue andpreceded by a − If the values in the log book are greater than asite/patient minimum configurable value and less than a site/patientmaximum configurable value, the values are displayed in green.Additionally, if multiple readings for a given day and a given time slotare available, the first reading for that day and time slot isdisplayed, but the other values are available by moving the mouse overthe first reading. In response, a pop-up window is displayed thatincludes some or all of the readings for that day and time slot.

By selecting the date hypertext link or graphical user interface widget1514 in the upper left corner of the blood sugar log 1510 of FIG. 15,the screen changes to that of a date interval selection screen or window1570, as shown in FIG. 16. In the date interval selection screen orwindow 1570, the patient may select the dates for which the blood sugarlog 1510 is to display blood glucose values. The patient may selecteither the last 14 days entered in the blood sugar log book by an optionbutton 1572 or a “Start Date/End Date” option by selecting a secondoption button 1574. If the “Start Date/End Date” option is selected, thepatient may enter the start and end dates into, for example, standarddata entry input boxes 1576, as shown in FIG. 16.

The graphing icons in the toolbar 1520 located on the clinical datascreen 1500 may change the presentation of the blood sugar log 1510. Forexample, if the patient selects the animated line chart icon 1522, thetabular blood sugar log 1510 is replaced with a linearly plotted graph1530, as shown in FIG. 17. This linearly plotted graph 1530 plots bloodglucose values against time during the date interval that is displayedabove the graph. Similarly, selecting the animated “Histograms” icon1524 displays the data contained in the blood sugar log 1510 as twohistograms 1540 and 1542, shown in FIG. 18. The first histogram 1540plots blood glucose values against days of the week, and the secondhistogram 1542 plots blood glucose values against the daily timeintervals.

These different data presentations may help the patient to understandany daily or weekly patterns of changes in blood glucose values. Suchpatterns would usually be discussed in an actual clinic visit to exploreactivities surrounding the time during which such changes of bloodglucose values occur, so as to avoid possible hypoglycemic orhyperglycemic events

When the pie chart icon 1526 of FIG. 15 is selected, the data containedin the blood sugar log 1510 is shown as percentages of blood glucosereadings above, below and within the target range of clinically desiredblood glucose values in a pie chart 1550, as shown in FIG. 19. Sectorsof the pie chart may also be color coded to reflect the percentage ofblood glucose readings above, below and within a clinical target rangeas explained in the legend 1552. For example, a sector of the pieindicating the percentage of blood glucose readings that are above thetarget blood glucose range may be colored red, while those that arewithin the target range are colored green and those below the targetrange are colored blue. Alternatively, various shadings or graphics maybe used to distinguish between the pie chart sectors.

Selecting the multiple pie chart icon 1528 results in a pie chart1560-1564 for each specific daily interval of the blood sugar log 1510,as shown in FIG. 20. Each pie chart 1560-1564 indicates the percentageof blood glucose readings that were above, below or within the targetblood glucose range for a particular time interval. Again, sectors ofeach pie may be color coded to reflect the percentage of blood glucosereadings above, below and within a clinical target range as explained inthe color-coded legend 1566, or indicated by pluses or minuses (notshown). When no blood glucose readings correspond to a particular dailytime interval, a message 1568, for example, “No data for this timeslot”,may be presented, as shown in FIG. 20. The line charts 1530 shown inFIG. 17, the histograms 1540 and 1542 shown in FIG. 18, and the piecharts shown in FIGS. 19 and 20 are tied to the data range and the datadisplayed in the blood sugar log 1510. If the date range is changed inthe log book, then the date range on the graphs also changes.

Selecting the lab results icon 1502 of the toolbar 1501 changes thedisplayed one of the clinical data screens 1500-2100 or 6800 to thelaboratory test results screen 1600. FIG. 21 shows one exemplary set ofsuch laboratory test results displayed in the laboratory test resultsscreen 1600. The laboratory test results screen 1600 presents laboratorytest results of for example HbAIC, cholesterol, HDL, LDL, triglycerides,and urine microalbumin in a table 1610, indicating the laboratory testand the month the laboratory test was taken. When any of the laboratorytests having an associated hypertext link or graphical user interfacewidget is selected, an on-screen contextual message (not shown) mayappear to explain what the laboratory test measures, its clinicalsignificance and the acceptable clinical range of test values.

In FIG. 21, the patient has HbA1C test results that fall within theacceptable clinical range for the month of May. In this case, a simplecomparison of the laboratory results with acceptable clinical valuesstored in the relational database 232 by the clinic system 200 isperformed in real-time to determine whether the value is acceptable. Forexample, in various exemplary embodiments, if the HbAlC value is lessthan a site/patient configurable value, then a text message and/or anaudio message is presented to the user in a message portion 1620. Asshown in FIG. 21, the illustrated test results are below a site/patientconfigurable value. As a result, because the test results areacceptable, the clinic system may present in the message portion 1620 acongratulatory comment from the patient's healthcare practitioner, suchas “Great Ale this month-Keep it up”, possibly accompanied by the soundof applause. This message and sound of applause provide motivation tothe patient, when the patient has done well in managing his or her bloodglucose values and are meant to reflect the feedback a patient wouldnormally receive during a clinic visit from his or her healthcarepractitioner.

Selecting the medication icon 1504 of the toolbar 1501 changes thedisplayed one of the clinical data screens 1500-2100 or 6800 to amedications screen 1700. The medications screen 1700 shows themedications used by the chronic illness patient. In the particularexemplary embodiment shown in FIG. 22, the medications screen 1700 isone that is appropriate for a diabetic patient. It should be appreciatedthat the contents of the medications screen will change depending on theparticular chronic illness, as illustrated by the second exemplaryembodiment of the medications screen 3700 shown in FIG. 37.

In the prescription portion 1710, the date and time of the currentprescription for insulin, which has been prescribed by clinic healthcarepractitioners, may be displayed. In the prescription portion 1710 of themedication screen 1700 displayed for a diabetic patient, an insulinmedication table 1712 may indicate that both long and short actinginsulin are currently prescribed for the patient. display the common ortrade names of the prescribed insulin, and the dosage values and time ofday that the prescribed type of insulin is to be taken. Previousprescription orders for insulin may be viewed by selecting the previousprescription hypertext link or graphical user interface widget 1714. Theprevious prescription order date is then displayed above the insulinmedication table 1712, which now contains information about the previousprescription order. After reviewing the previous order, the patient mayadvance the prescription order to the current prescription date andorder by selecting a next prescription graphical user interface widgetor hypertext link (not shown), which will be displayed if the currentlydisplayed prescription information is not that for the latest insulinprescription.

For diabetic patients who have an insulin pump, the insulin prescriptioninformation may be presented in a separate table (not shown) thatincludes, for example, the insulin pump prescription showing time versusbasal rate, bolus information by meal including grams of carbohydrate,bolus size, insulin to carbohydrate ratio, prescribed supplementalinsulin and information explaining how insulin converts various foods tocarbohydrates.

In an oral medication portion 1720 of the medication screen 1700, thedate of the current prescription of oral prescription drugs other thaninsulin, which has been prescribed by clinic healthcare practitioners,and an oral medication table 1722 is shown that may indicate the type oforal medication, its name, the dosage and number of tablets per dose,and the frequency with which the medication is to be taken. As describedabove, previous oral medication prescription orders and informationconcerning the previous prescription orders may be reviewed by selectinga previous prescription hypertext link or graphical user interfacewidget 1724 located above the oral medication table. Similarly, afterreviewing a previous oral medication prescription order, selecting anext prescription hypertext link or graphical user interface widget (notshown) advances the oral medication prescription date and prescriptionorder.

In another medication portion 1730 of the medications screen 1700,non-prescription medications and other prescription medications,prescribed by a non-clinic healthcare practitioner, may be displayed.These other medications are entered into a displayed other medicationtable 1732 by the patient when he or she selects the add othermedication icon 1740. Selecting the add other medication icon 1740changes the medications screen 1700 to the add medications screen 1800shown in FIG. 23. As shown in FIG. 23, the add medications screen 1800includes a data entry table 1810 comprising a number of data entry inputboxes 1812 and drop down list boxes 1814, in which the patient entersthe information about other medications. The patient enters into theappropriate data entry input box 1812 via the patient data terminal 120,the name of the medication, when it was taken, its dosage, and thepurpose of the medication. The frequency with which the medication istaken may be entered by accessing one of the drop list boxes 1814 thatlist once, twice and three times per day, or the like.

Information concerning the various medications taken by the patient maybe communicated to other computerized clinical systems that analyze theinformation for possible adverse drug interactions. If such a systemdiscovers a possible adverse drug interaction, this information may thenbe communicated to the clinical management system for chronic illnessesfor inclusion in, for example, an alert displayed in the alerts portion940. Alternatively, such information may be sent to a clinic healthcarepractitioner, who in turn informs the patient.

Selecting the animated exercise log icon 1505 changes the displayed oneof the clinical data screens 1500-2100 or 6800 to an exercise datascreen 1900. The exercise data screen 1900 includes an exercise log1910, as shown in FIG. 24, and an exercise event entry portion 1920. Theexercise event entry portion includes a number of drop down list boxes1922-1926 in which the patient may enter the date, type of exercise, andduration of exercise, and a data entry input box 1928 for entering thepatient's comments. Entering the date of a log entry may be facilitatedby a set of standard drop down list box 1922 that allows the patient toselect a particular month, date, and year. Similarly, a type of exercisedrop down list box 1924 may provide for the selection of, for example,biking, jogging or running, swimming, walking or hiking, golfing, armchair exercising, other sports, gardening, housework, and otheractivities. The duration of an exercise may be entered by a drop downlist box 1926 that provides for the selection of 15, 30, 45 and 60minutes or an “other” time interval. The data entry input box 1924permits the patient to enter the patient's comments, via the patient'sdata terminal 120, which the patient feels will be relevant to thehealthcare practitioner or may more fully describe an exercise activityor its duration. Comments from a healthcare practitioner may also bedisplayed in the exercise data screen 1900, indicating to the patientthat the healthcare practitioner is reviewing and evaluating the levelof the patient's physical activity.

Selecting the blood pressure icon 1506 of the toolbar 1501 changes thedisplayed one of the clinical data screens 1500-2100 or 6800 to a bloodpressure data screen 2000. The blood pressure data screen 2000 includesa patient blood pressure log 2010, as shown in FIG. 25. The bloodpressure log 2010 is a table that displays blood pressure values bydate, that are obtained from an automated or manual medical device 122that the patient may connect to the patient's data terminal 120 and/ordirectly to the network 110. The blood pressure log 2010 allows forpatient-entered comments. The blood pressure data screen 2000 alsoincludes a manual entry portion 2020 that includes a number of dataentry boxes 2022-2028. The patient may enter the date using drop downlist boxes 2022, while systolic and diastolic blood pressures andcomments may be entered into, for example, by the data entry input boxes2024, 2026 and 2028, respectively. Comments (not shown) from thehealthcare practitioner about the patient's blood pressure may bedisplayed in the blood pressure data screen 2000. It should beappreciated that, if the clinic system 200 is able to accept data froman electronic blood pressure device as the medical device 122, themanual entry portion 2020 may be omitted.

Selecting the data summary and healthcare practitioner comments icon1507 changes the displayed one of the clinical data screens 1500-2100 or6800 to the summary screen 2100. The summary screen 2100 includes atabular summary 2110, as shown in FIG. 26. In FIG. 26, the tabularsummary 2110 presents by date, for example, the average blood glucosevalue, the standard deviation of the blood glucose values, the number ofhypoglycemic and hyperglycemic events, the percentage of blood glucosereadings within the desired target range, the average number of bloodglucose readings per day, and the number of days for which the clinicaldata is summarized. When reviewing the tabular summary 2110 of FIG. 26,the patient may enter comments regarding his or her latest blood glucosevalues, for example, by a standard data entry box 2120 as shown in FIG.27, to which the healthcare practitioner may reply.

By selecting the date icon 2112 in the upper left corner of the tabularsummary 2110 of FIG. 26, a data selection screen or window 2800 isdisplayed, as shown in FIG. 28. The data selection screen or window 2800shows two options, a “Last 30-Day Summary” option button 2810 or a“Start Date/End Date” second option button 2820. A “Cancel” button 2840may cancel the dates' selection screen and return the patient to thesummary screen 2100 shown in FIG. 26.

Selecting the patient message list icon 1508 of the toolbar 1501 changesthe displayed one of the clinical data screens 1500-2100 displayed inthe central data area 710 to the patient message list screen shown 6800in FIG. 68. The patient is presented with a list of messages sent by thepatient's healthcare practitioner or by the patient, as shown in FIG.68. Information, such as the date a message was sent. to whom themessage was sent, who sent the message, and the subject/title of themessage may be presented. In various exemplary embodiment, all unreadmessages in the list are preceded by a red asterisk.

When the patient selects one of the underlined subject/titles, theclinical management system retrieves the selected message for thepatient, as shown in FIG. 69. A message list screen 6900 appears withinformation such as the date the message was sent, to whom the messageis addressed, who sent the message, the subject/title of the message andthe message itself. If the entire message does not fit within themessage list screen 6900 horizontal and/or vertical scroll bars arepresented for the patient to scroll through the message (not shown). Atthe end of the message there is a reply button 6910 and a close button6920. When selected, the reply button 6910 allows the patient to send aresponse message to whomever sent the message (not shown). The closebutton 6920 allows the patient to exit the message list screen 6900 andreturn the patient to the patient message list screen 6800 of FIG. 68(not shown). The patient may also exit from the message list screen 6900by selecting the standard window exit icon (not shown) in the top righthand corner of the message list screen 6900 to return to the patientmessage list screen 6800.

The patient may also create and add a new message to the messagesdisplayed in the patient message list screen 6800. The patient selects a“Select a CareTeam Member” drop down list box 6810. The “Select aCareTeam Member” drop down list box 6810 provides a list of thehealthcare practitioners in the chronic illness management system 100.The patient then selects the healthcare practitioner the patient wishesto address the message to (not shown). The patient may also provide asubject/title for the message, but this is not required. The patientdoes this by simply typing in the subject/title in the “Subject” dataentry box 6820 in FIG. 68.

If the patient decides to discard the message, has made an error, orwants to change to whom the message is addressed to and/or thesubject/title of the message, the patient can select the reset button6830. When selected, the reset button 6830 clears to whom the message isaddressed to and clears the “Subject” data entry box 6820 The functionof the reset button 6830 can also be accomplished by selecting adifferent individual from the “Select a CareTeam Member” drop down listbox 6810 for whom the message is addressed and by backspacing over theincorrect data entry and then typing the correct data in the “Subject”data entry box 6820.

After the patient has selected the healthcare practitioner to whom themessage is addressed and typed a subject/title for the message(optional), the patient selects the “Add Message” button 6840. When thepatient selects the “Add Message” button 6840, the patient message listscreen changes to the add message screen shown in FIG. 70. The add amessage screen 7000 displays the patient's name as who the message isfrom, the name of the healthcare practitioner to whom the message isaddressed and the subject/title, if provided by the patient.Additionally, there is a message data entry box 7010, a submit button7020, a reset button 7030, and a cancel button 7040. The patient thenenters his or her message into the message data entry box 7010 by usingthe keyboard or some other data entry device. Once finished, the patientselects the submit button 7020 to send the message. If the patient isunsatisfied with the inputted message and wishes to discard all of itscontents, the patient simply selects the reset button 7030 or backspacesover the undesired portions of the message. However, if the patientwishes to disregard sending a message all together, the patient canselect the cancel button 7040. This returns the patient to the patientmessage list screen 6800 of FIG. 68.

When a diabetic patient selects the education icon 836 of the mainpatient data screen 700 shown in FIG. 10 or included in any other screenhaving a blue color-coded frame 800, the screen displayed in the centraldisplay area 710 changes to a diabetes education screen 2200, as shownin FIG. 29. The diabetes education screen 2200 includes a number oficons 2210-2250 that cause screens providing more detailed informationon a particular subject to be displayed. The patient may then select oneof the icons 2210-2250, for example, the icon 2210 labeled “What IsDiabetes?”. In response, as shown in FIG. 30, a second education screen2300 for the selected topic will be displayed in the central displayarea 710.

The displayed educational topics may include, for example, hypertextlinks or graphical user interface widgets associated with various wordsor phrases 2310, or Web sites 2320, as shown in FIG. 30. Selecting sucha word or phrase 2310 may result in an on-screen contextually relevantmessage being displayed that explains or identifies the selected word orphrase. Selecting such a Web site 2320 causes the system to access theassociated Web site. Upon leaving the accessed Web site, the patientreturns to the displayed educational topic.

When a diabetic patient selects the contacts icon 838 of the mainpatient data screen 700 shown in FIG. 10 or included in any other screenhaving a blue color-coded frame 800, the screen displayed in the centraldata area 710 changes to a healthcare practitioner contact screen 2400.The healthcare practitioner contact screen 2400 includes a graphic andpictorial representation of the clinic's diabetes treatment andmonitoring team, as shown in FIG. 31. A hypertext link or graphical userinterface widget 2410-2440 is associated with each team member. An emailaccess icon 24122442 is also associated with each team member. If thepatient selects the hypertext link or graphical user interface widget2410-2440 of a team member, a short biographical sketch (not shown) ofthe team member is displayed in a separate window or a separate screen.This biographical sketch helps to familiarize the patient with theclinicians handling the patient's case. If the email access icon2412-2462 is selected, a dialog box containing the corresponding emailor message address of the selected team member where that team membercan be reached is displayed. if the patient selects the Support GroupMessage icon (not shown), a dialogue box (not shown) containing thesupport group's e-mail or message address where the patient may chatwith others having the same chronic illness. By selecting the TechnicalSupport Email icon 2462, the screen may show a dialogue box (not shown)containing the technical support group's e-mail or message address toassist the patient with technical problems associated with communicatingwith the system and using it properly.

It should be appreciated that the screens shown in FIGS. 29-31 are thediabetes education screens 2200 and 2300 and the contact screen 2400 asdisplayed to a healthcare practitioner. The various icons used whendisplaying these screens to the healthcare practitioner are described ingreater detail below with respect to FIG. 50. That is, the diabeteseducation screen 2200 and 2300 and the contact screen 2400 display thesame information in the central data area 710 to both patients and tohealthcare practitioners. The only significant difference whendisplaying these screens is that the particular tool bar icons displayedin the frame 800 depends on whether these screen are being displayed toa health care practitioners, as shown in FIGS. 29-31, or to a patient.In that later case, the frame 800 shown in FIGS. 10-28 would bedisplayed.

When an authorized kidney disease patient signs on to the clinic system200 using the clipboard of FIG. 7, the screen changes to show the kidneymain patient data screen 3200, shown in FIG. 32, that is appropriate fora patient to manage the patient's kidney disease. The kidney mainpatient data screen 3200 includes a frame 3202 with upper and left-sideborders, and a central display area 3210, as shown in FIG. 32. Thebackground 810 of the upper and left-side borders of the frame 3202 ofthe main patient data screen 3200 may be colored green to signify akidney disease patient. The background 810 of the upper border of theframe 3202 includes the underlined patient's name 3220, the date ofbirth 3222, an icon 3224 linked to another screen of the graphical userinterface and a selectable icon or hypertext link 3226 linked to, forexample, a Web site for the associated with the clinic. Selecting theunderlined patient's name 3220 changes the screen to the “PatientInformation Update” screen, as discussed above and shown in FIG. 12. Theleft border of the frame 3202 may include, for example, icons for“messages” 3232, “clinical data” 3234. “education” 3236, and “contact”3238 that change the information displayed in the central display area3210 and a “logout” 3239 icon that accesses the screen for the cliniclobby 400. Among the icons in the left border of the frame 3202, onlythe “education” 3236 icon has changed its appearance from that of theframe 800 shown in FIG. 10, showing, instead, a pair of kidneys. Byselecting the “education” 3236 icon for the kidney patient, an on-screencontextually relevant message may read “dialysis education site”.

The initial screen presented to the kidney disease patient upon enteringthe kidney disease clinic is the main patient data screen 3200 with“ALERTS:” 3250, “MESSAGES:” (not shown) and “REMINDERS:” (not shown)displayed in the central display area 3210 of FIG. 32. In FIG. 32, theunderlined “What's New?” 3242 and the drop down list box 3244 labeled“Kidney Disease News Archive” are connected to information stored in therelational database 232 of the clinic system 200 concerning kidneydisease. For example, selecting “What's New?” 3242 displays the latestnews concerning kidney disease and peritoneal dialysis, as shown in FIG.33. If the amount of information in the news of FIG. 33 exceeds the sizeof the central display area 3210, a vertical and/or horizontal scrollbar located at the right border of the screen (not shown) allows thepatient to view the entire news

In FIG. 32, the information concerning “ALERTS:” 3250 derives from theclinic system's 200 analysis of quantitative clinical data submitted bythe patient using a medical device 122 for at-home peritoneal dialysis,blood pressure and weight measures submitted by the patient, andlaboratory test results entered into the clinic system 200 by thepatient's healthcare practitioner. The information presented to thepatient concerning “ALERTS:” 3250, “MESSAGES:” and “REMINDERS:” isautomatically analyzed in real-time by the clinic system 200 from datastored in the relational database 232 when the patient initiallyaccesses the main patient data screen shown in FIG. 32. The “ALERTS:”3250 summarize those events and activities, which may be detrimental tothe patient and may include, for example, the date of the last PD, thatis, peritoneal dialysis data received, weight gain or loss, changes inblood pressure, and clinical laboratory results including creatinine,potassium, albumin, glucose and phosphate levels, and Kt/V, that is, ameasure of the quantity of dialysis delivered. In FIG. 32, for example,the system has determined that the patient has not submitted PD data,that is, peritoneal dialysis data, for 26 days. The “ALERTS:” 3250 mayalso emphasize the number of days a peritoneal dialysis datum has notbeen received by using a red color for the number, corresponding to thecolor of “ALERTS:” 3250. Additionally, by selecting underlinedlaboratory tests or medical terms in “ALERTS:” 3250, an on-screencontextually relevant message (not shown) may be displayed to furtherexplain the laboratory test or medical term.

The information concerning “MESSAGES:” for a kidney disease patient inthe main patient data screen 3200 may include, for example, that Kt/V orother laboratory test values are in a clinically acceptable range, thus,indicating good management of the kidney disease by the patient. Goodand poor management of the patient's kidney disease may be indicated tothe patient by various messages, including animated smiling or frowningfaces (not shown) and accompanying sounds.

The information concerning “REMINDERS:” for a kidney disease patient inthe main patient data screen of 3200 may include reminders entered intothe clinic system 200 and stored in the relational database 232 by thepatient's healthcare practitioners about upcoming medical visits,medical exams and laboratory tests, and health care tips.

Selecting the “clinical data” icon 3234 of FIG. 32 or any other patientscreen having a green ft⁻ante, changes the information displayed to thatof FIG. 34, showing a peritoneal dialysis prescription 3404 and theclinical data submitted by the patient to the system, that is, the“Automated Cycler Flow Sheet” 3410. The “Lab Results” icon 3430 and the“Medication” icon 3434 located above the current peritoneal dialysisprescription table 3404 changes the type of information displayed in thecentral display area 3405 of FIG. 34. The “Automated Cycler Flow Sheet”3432 icon of all patient screens having the green frame displays the“Automated Cycler Flow Sheet” 3410 of FIG. 34. In FIG. 34, the currentperitoneal dialysis prescription shows the date and time of theprescription above a peritoneal dialysis prescription table 3404including prescription information relating to, for example, therapytime, dwell time, number of cycles, total volume, fill volume, and Lastfill volume. The clinical data of the “Automated Cycler Flow Sheet” 3410are the date and time of the peritoneal dialysis, the percentageconcentrations of the dextrose solutions used, the volume of initialdrain, the volume of total UF, that is ultrafiltrate, blood pressure,and body weight, as shown in FIG. 34.

Selecting any of the icons 3420 located above the Total UF, BP or WTcolumns of the “Automated Cycler Flow Sheet” of FIG. 34 changes thepresentation of the clinical data of the column to a linear graph ofthat column's variable versus the Automated Cycler Flow Sheet's timeperiod. For example, FIG. 35 shows, respectively, the changes in TotalUltrafiltrate, Blood Pressure and Weight over the time period of theAutomated Cycler Flow Sheet as linearly plotted graphs.

Selecting the “Lab Results” icon 3430 of FIG. 34 or any other patientscreen having a green frame 3202 changes the type of clinical datadisplayed to that of laboratory test results, as shown in FIG. 36. FIG.36 may present twelve dates on which laboratory test results may bedisplayed in a table 3610, with rows corresponding to a particular typeof laboratory test and columns corresponding to a test date_ The clinicsystem 200 may display more than twelve test dates with additional tabledisplays. The laboratory test results displayed may include, but are notlimited to, for example, Kt/V, albumin, calcium, creatirune, ferritin,glucose, HGB×3 (Hemoglobin times 3), iron, phosphate, potassium, PT1⁻1(parathyroid hormone), TIBC (total iron binding capacity), TSH (thyroidstimulation hormone), T3, T4, T7 (thyroid studies), cholesterol, HDL(high density lipids), LDL (low density lipids), triglycerides, HBSAG,HBSAB (hepatitis B surface antigens), 1-{EPCAP (hepatitis C surfaceantigen) and Hb I AC (hemoglobin A I C)

When any of the laboratory tests of FIG. 34 is selected, an on-screencontextual message (not shown) may appear to explain what the laboratorytest measures, its clinical significance to managing the illness and theacceptable range of clinical test values. When laboratory test resultsindicate that the patient is managing his or her illness well, theclinic system 200 may present a congratulatory message above the table3610 (not shown). Laboratory test results may be color coded torepresent values above, below and within acceptable clinical ranges. Forexample. red values may represent high results, blue values mayrepresent low results and green values may indicate those within aclinically acceptable range. Alternatively, pluses and minuses mayindicate high and low values, respectively.

Selecting the “Medication” icon 3434 of FIG. 34 or of any other patientscreen having a green frame 3202 changes the type of clinical datadisplayed to that of a “Medications” table 3710 and an “OtherMedications” table 3720, as shown in FIG. 37. The medications prescribedby the clinic healthcare practitioners are entered into a “Medications”table 3710 for review by the healthcare practitioner and patient. The“Medications” table 3710 may include, for example, the medication name,its dosage, its units, its frequency taken, its route of administration,the prescription start and stop dates, and instructions to the patient.

The “Other Medications” table 3720 of FIG. 37 includes information aboutnon-prescription medications and other prescription medications,prescribed by non-clinic healthcare practitioners for the patient Thus,the “Other Medications” table 3720 of FIG. 37 provides the patient witha mechanism to enter outside medications the patient may be taking thatthe healthcare practitioner may not know about. This information isentered into the “Other Medications” table 3720 by the patient when heor she selects the “Add other medication” 3735 icon in the upper rightcorner of FIG. 37. The other medications arc added to the table by thedata entry tables discussed above in relation to the diabetic patient,as shown in FIG. 23.

When a kidney disease patient selects the “education” icon 3236 of FIG.32 or any other patient screen having a green frame, the upper border ofthe frame 3202 displays Pager and Clinic telephone numbers, while thecentral display area 3210 displays the main education page for kidneypatients, as shown in FIG. 38. In the main education page of FIG. 38,the patient may select among the three underlined educational topics fordisplay: “Kidney Disease and YOU”; “PD-Doing It Right!, Plus: Problemsand What YOU should know”; and “Daily Life, Food, Fluids, Meds and FUN”.The main education page of FIG. 38 may also display a “PD News” 3802icon that when selected displays the latest news about kidney diseaseand/or peritoneal dialysis. A drop down list box 3804, labeled “KidneyDisease News Archive”, may allow patients to access archival articlesstored in the relational database 232 of the clinic system 200 fordisplay. Additionally, the central display area may display a “Recipes”icon 3806 that when selected displays a current recipe. A drop down listbox 3808, labeled “Recipes”, may allow patients to access other recipesfor display in the central display area, as shown in FIG. 39.

Selecting the underlined topic of “Kidney Disease and YOU” in FIG. 38changes the screen to that shown in FIG. 40. Selecting an underlinedword or phrase in the educational article of FIG. 40 may provide anon-screen contextually relevant message (not shown) that defines theword or phrase. By selecting the underlined, quoted article, “How theKidney Works” of FIG. 40, the system accesses a link to a Web site, forexample, nephron.com, that explains the workings of the kidney to thepatient. Selecting the underlined phrase “Return to Main Education Page”allows the patient to return to the display of FIG. 38.

Selecting the underlined topic of “PD Doing It!, Plus: Problems and WhatYOU should know” in FIG. 38 changes the information displayed in thecentral display area to that shown in FIGS. 41A and 41B. Selecting anunderlined word or phrase in the educational article shown in FIGS. 41Aand 4IB may provide an on-screen contextually relevant message (notshown) that defines the word or phrase. When other underlined sentences,such as, “Washing AND drying your hands—read about why it's so importanthere”, of FIG. 41A arc selected, an abstract of the article, “WashingAND drying your hands—read about why it's so important here”, may bedisplayed, as shown in FIG. 42.

The section “PD INFORMATION” of FIG. 41A, entitled “How to do a SAFEEXCHANGE”, may contain a drop down list box 4105, labeled “Your UnopenedDialysate Bag is”, that provides a checklist 4310 for a patient tofollow when checking his or her unopened dialysate bag to assure properdialysis technique, as shown in FIG. 43. Similarly, selecting the dropdown list box 4110, labeled “Your area is”, provides a checklist 4410for the area the patient selects for his or her peritoneal dialysis, asshown in FIG. 44.

The section of “PD INFORMATION” of FIG. 41A, entitled “3 Steps to a SAFEExchange”, shows three underlined terms, that is, “DRAIN” 4120, 'PILL″4122 and “DWELL” 4124 in a horizontal row. Selecting an underlined termchanges the screen to show the information concerning the selectedunderlined term, as shown for “DRAIN” 4120, “MU” 4122 and “DWELL” 4124,in FIGS. 45A-45C, respectively. After reading any of the “3 Steps to aSAFE Exchange” in FIGS. 45A-45C, the patient may return to sectionentitled “3 Steps to a SAFE Exchange” of FIG. 41A by selecting thephrase, “Click here to dose window”.

The section of “PD INFORMATION” of FIG. 41B, entitled “Problem List”,shows five underlined phrases, that is, “Cloudy Bag” 4150, “Unclear butnot Cloudy Bag” 4152, “Leaking Equipment” 4154, “Cramps” 4156 and “ExitSite Infection” 4158 in a horizontal row. Selecting an underlined phrasechanges the screen to show the information concerning the underlinedphrase, as shown for “Cloudy Bag” 4150, “Unclear but not Cloudy Bag”4152, “Leaking Equipment” 4154, “Cramps” 4156, and “Exit Site Infection”4158, in FIGS. 46A-46E, respectively. After reading about any of theproblems of peritoneal dialysis, the patient may return to the sectionentitled “Problem List” of FIG. 4113 by selecting the phrase, “Clickhere to close window”.

Selecting the underlined topic of “Daily Life, Food, Fluids, Meds andFUN” of FIG. 38 changes the information displayed in the central displayarea to that shown in FIGS. 47A-471. The underlined topics presentedunder the “Daily Routines” of FIG. 47A may include but are not limitedto “Fluids”, “What you eat”. “Your weight”, “Blood Pressure”,“Medications”, “Eating Out”, “Exercise”, “Travel”, “Socializing”, and“Learn More”. In FIG. 47A, selecting any of the underlined topics listedpresents an on-screen contextually relevant message between the twocolumns of under lined topics. For example, FIG. 48 shows thecontextually relevant message of “Here are some Tips” 4810 when theunderlined topic of “Eating Out” is selected. Additionally, on-screencontextually relevant messages may be displayed for underlined words andphrases within the displayed texts of the underlined topics, shown inFIGS. 47A-47L Links to other web sites, concerning kidney disease, mayalso be located within the texts of the underlined topics, shown inFIGS. 47A-471. At the bottom of the text of each underlined topic, shownin FIGS. 47A-471 is an underlined phrase “Return to Top” that whenselected returns the patient to the top of “Daily Life, Food, Fluids,Meds and FUN” shown in FIG. 47A.

When a kidney disease patient selects the “contacts” icon 3238 of FIG.32 or any other patient screen having a green frame 3202, the screenchanges to that of a graphic and pictorial representation of theclinic's kidney disease treatment and monitoring team, as shown in FIG.49. If the patient selects a team member's picture icon 4920-4940, ashort biographical sketch (not shown) of the team member may appear onthe screen. This biographical sketch helps to familiarize the patientwith the clinicians handling the patient's case. If the email accessicon 4922-4942 is selected, a dialog box containing the correspondingemail or message address of the selected team member where that teammember can be reached is displayed. If the patient selects the “SupportGroup” 4910 icon, the screen may show a dialogue box (not shown)containing the support group's e-mail or message address where thepatient may chat with others having the same chronic illness.

When an authorized healthcare practitioner of the clinic signs into theclinic by entering his or her name and a password on the clipboard shownin FIG. 7, the screen automatically changes to display informationconcerning the practitioner's patient selection in the central displayarea 5010 of the main practitioner data screen's 5000, as shown in FIG.50. Information concerning the practitioner's patient selection may alsobe displayed by selecting the animated “alerts and reminders” 5032 icon.The background 810 of the left side border of the frame 5002 may be, forexample, blue, indicating that the practitioner's patient selection isfor those patients enrolled in the diabetes clinic, green, indicatingthat the practitioner's patient selection is for those patients enrolledin the kidney disease clinic, or another color for some other chronicillness or related clinic. In FIG. 50, for the practitioner's patientswithin the diabetes clinic, the main practitioner data screen 5000 caninclude a message list icon 5031, while the left side border of theframe 5002 may include, for example, icons for “alerts and reminders”5032, “register patients or practitioners” 5033, “enter patient's labresults” 5034, “patient reminders” 5035, “On-line chatroom” 5036,“education” 5037, “contacts” 5038, and “logout” 5039, that change theinformation displayed in the central display area of the mainpractitioner data screen. When selected, each of the icons 5031-5039 maybe identified by an on-screen contextually relevant message when theon-screen indicator is placed over that icon. Additionally, a cumulativecount of new messages for the healthcare practitioner from all of thepatients of that healthcare practitioner can be presented on thisscreen, for example, located on the message list. A link to themessaging screen 7100 is provided by the message list icon 5031 attachedto the count.

The central display area 5010 of the main practitioner data screen 5000is used by a healthcare practitioner to select a patient whose data thehealthcare practitioner would like to review. As shown in FIG. 50, thereare three lists of patients the healthcare practitioner can select apatient from. A first, an all patients list box 5024 lists all patients.A second, or alerts list box 5020, lists only those patients to whomalerts have been sent. A third, or new data list box 5022, lists onlythose patients that have submitted new data, such as, for example, bloodglucose data, peritoneal dialysis data or clinical data from otherchronic illness monitor device.

Selecting a patient's records for review by the healthcare practitionermay be prioritized by allowing the healthcare practitioner to choosepatient records listed in, for example, the alerts list box 5020, thatcontains a list of those patients to whom alerts have been sent. Forexample, in various exemplary embodiments, such as that shown in FIG.50, patients are prioritized based on those requiring attention andamong all patients. Those patients requiring higher priority attentioninclude those with active alerts and those with new data. The patientswith active alerts and/or new data appear in the alerts list box 5020 ornew data box 5022 and the label for the alerts list box 5020 ispresented in red. New data, for example, includes blood glucose data(for a diabetic patient) sent in that has not been reviewed by ahealthcare practitioner and lab data that has not been reviewed.Selecting a patient from the list contain in the alerts list box 5020 ornew data box 5022 brings up the messages screen 5100, shown in FIG. 51,for that patient, displaying the alerts contained in the alerts list box5020, any messages, and reminders sent to that patient. This alsoremoves that patient from the list contained in the alerts list box 5020and the new data box 5022.

In various exemplary embodiments, the reasons for alerts may include,for example, one or more of the average blood glucose level beinggreater than site/patient configurable value, the number of days sincereceiving new data being greater than site/patient configurable value,the HbAIC value being greater than site/patient configurable value, morethan 3 hypoglycemic events having occurred within site/patientconfigurable time frame, and/or more than 6 hyperglycemic events havingoccurred within site/patient configurable time frame.

Additionally, patients are prioritized based on new data and appear inthe new data list box 5022 with the label for the box presented ingreen. Selecting a patient from this list brings up the messages screen5100, shown in FIG. 51A, for that patient. The messages screen 5100displays that patient's alerts, messages, and reminders and removes thatpatient from the alert list box 5020 and the new data list box 5022. Allpatients assigned to the healthcare practitioner appear in the allpatients list box 5024 and the label for all patients list the box is5024 presented in blue. Selecting a patient from this list brings up thepatient's log book as the initial screen, but does not remove thatpatient from the list contained in the alerts list box 5020 or the newdata list box 5022 if that patient is contained in that list.

After selecting a patient's name from the list of patients contained inthe alerts list box 5020 or the new data list box 5022, informationconcerning “ALERTS:” 5150, “MESSAGES:” 5160 and “REMINDERS:” 5170 forthe selected patient is displayed. as shown in FIG. 51A for a diabeticpatient, and for “ALERTS:” 5190, as shown in Fig. SIB for a kidneydisease patient. Alternatively, the healthcare practitioner may selectpatient records from, for example, the all patients list box 5024, asshown in Fig SO.

In FIG. 51A, the upper border of the frame 5102 for diabetic patientsmay include a patient's picture 5101, the patient's underlined name5105, date of birth 5107, and icons accessing the diabetic patient's“Lab Results” 5130 (see FIG. 21), “Blood Sugar Log” 5132 (see FIG. 15),“Medication” 5134 (see FIG. 22), “Blood Pressure Log” 5138 (see FIG.25), “Exercise Log” 5136 (see FIG. 24), “Data Summary and Healthcarepractitioner Comments” 5139 (see FIG. 26) and “Message List” 5140 (seeFIG. 68) as described above for information displayed for diabeticpatients. In FIG. 51B, the icons access the kidney patient's “LabResults” 5158 (see FIG. 36), “Automated Cycler Flow Sheet” 5152 (seeFIG. 34), and “Medications” 5154 (see FIG. 37) and the message list5156. Selecting the patient's picture 5101 automatically presents ascreen that allows the healthcare practitioner to send a message to thepatient. When the on-screen indicator is placed over the primary carehealthcare practitioner's icon 5170, the patient's primary carehealthcare practitioner is identified by name. Selecting the primarycare healthcare practitioner's icon 5170 may connect the clinichealthcare practitioner to the patient's primary care healthcarepractitioner by automatically providing a screen which allows the clinichealthcare practitioner to send a message to the patient's primary carehealthcare practitioner.

Selecting the “Medication” icon 5134 for the diabetic patient of FIG.5IA automatically changes the information displayed to an insulinprescription table 5210, a number of icons located above the insulinprescription table 5210 and the date the medication is being prescribed,as shown in FIG. 52. These icons include an insulin medication icon5235, an oral medication icon 5237 and an other medications icon 5239.The date insulin is prescribed and the insulin prescription table 5210is also displayed by selecting the insulin medication icon 5235, whichis identified by an on-screen message when the on-screen indicator isplaced over the insulin medication icon 5235. The patient's clinichealthcare practitioner may review previous insulin prescriptions byselecting the left-facing arrow 5215, which is identified by theon-screen message of “previous prescription” when the on-screenindicator is placed over the arrow 5215. After reviewing a previousinsulin prescription, the healthcare practitioner may advance theprescription date and the insulin prescription table 5210 by selecting aright-facing arrow (not shown), which is identified by the on-screenmessage of “next prescription” when the on-screen indicator is placedover the right-facing arrow.

The healthcare practitioner enters a new insulin prescription for thediabetic patient into the insulin prescription table 5210 of FIG. 52 byentering data into, for example, data input entry boxes 5250, from thehealthcare practitioner's data terminal 130. After entering data for anew prescription into the insulin prescription table 5210, thehealthcare practitioner may select the “Update” button 5255 to createthe new prescription table, which is automatically dated and timed atthe time of the updated entry.

For diabetic patients having an insulin pump, the information displayedupon selection of the insulin medication icon 5235 automatically shows abasal infusion data table 5310, a meal/bolus table 5320, and informationrelating to supplemental insulin and extra food convergence, as shown inFIG. 53 The healthcare practitioner enters the new insulin pumpprescription data into the basal infusion data table 5310 and meal/bolustable 5320 by, for example, drop down list boxes 5315 or data entryinput boxes 5325, and the data relating to supplemental insulin andextra food convergence into their, for example, data entry boxes 5335.To create a new insulin pump prescription, the healthcare practitionermay select the “Update” 5355 button at the bottom of the display of FIG.53.

Selecting the oral medications 5237 icon, for diabetic patients, locatedabove the insulin prescription table 5210 of FIG. 52, automaticallychanges the information displayed to a prescription date for oralmedications and an oral medication prescription table 5410, as shown inFIG. 54. The healthcare practitioner may review previously prescribedoral medications by selecting the left-facing arrow 5415 and afterreview may return to the current oral medication prescription table 5410by selecting the right-facing arrow (not shown), as described above.Entry of the new oral prescription information may be facilitated byprescribing drugs that are categorized by their function, for example,drugs which enhance insulin secretion, a drug which decreases glucoseproduction by the liver, drugs which slow the absorption of sugars, andglitazones. Entry of data into the oral prescription table 5410 may alsobe facilitated by allowing the healthcare practitioner to rapidly selecta particular drug within a functional category of drugs and to enterprescription information, for example, dosage, tablets per dose andfrequency taken into an appropriate, for example, drop down list box545, as shown in FIG. 55 For example, a 500 mg dose of the drug,Glucophage, may be entered into the drop down list box 5450, as shown inFIG. 54.

Selecting the Medications icon 5154 for kidney disease patients, of FIG.5113, automatically changes the information displayed to a “Medications”table 3710 and “Other Medications” table 3720, as described above andshown in FIG. 37. The healthcare practitioner may enter newprescriptions for medications by entering the appropriate data into the“Medications” table 3710 by, for example, a number of data entry inputboxes (not shown), corresponding to the “Medications” table's 3710 data.The healthcare practitioner may, similarly, view the appropriate dataentered by the patient into the “Other Medications” table 3720.

Selecting the “Other medications” icon 5239 of FIG. 52 automaticallychanges the information displayed to the “Other medications” table 5450,which corresponds to the diabetic patient's “Other medications” table1730 or 1732, shown in FIG. 22, for a practitioner selected diabeticpatient and to the kidney disease patient's “Other medications” table3720, shown in FIG. 37, for a practitioner selected kidney diseasepatient. These other medications may be non-prescription medications orthey may be medications that have been prescribed by other healthcarepractitioners for medical conditions not related to the patient'schronic illnesses. The clinic healthcare practitioner may wish to reviewthese medications for possible adverse drug interactions with thosedrugs the healthcare practitioner has prescribed, for possible sideeffects, or for other medical reasons.

Selecting the animated “Exercise Log” icon 5136 of FIG. 51A for thediabetic patient automatically changes the information displayed to apatient exercise log, as described above and shown in FIG. 24. Thehealthcare practitioner may view comments that the patient may haveentered into the exercise log using, for example, a data entry inputbox, that is displayed above the patient's Exercise Log 1910 or 1928 ofFIG. 24.

Selecting the “Blood Pressure” icon 5138 of FIG. 51A for the diabeticpatient, automatically changes the information displayed to a patient'sBlood Pressure Log 2010, as described above and shown in FIG. 25. Thehealthcare practitioner may view comments that the patient may haveentered into the blood pressure log using, for example, a data entryinput box, that is displayed above the patient's Blood Pressure Log 2010of FIG. 25.

Selecting the “Data Summary and Healthcare practitioner Comments” icon5139 shown in FIG. 51A for any data screen of the diabetic clinicportion of the clinic system 200 automatically changes the informationdisplayed to a table 5610, as shown in FIG. 56, corresponding to thepatient's tabular summary 2610 of the blood glucose values for a rangeof dates, as described above and shown in FIG. 26. The clinic healthcarepractitioner may enter comments into the “Healthcare practitionerComments” column of the table 5610 by, for example, a data input entrybox 5650, via the keyboard of the healthcare practitioner data terminal130, as shown in FIG. 56. In various exemplary embodiments, if ahealthcare practitioner writes a comment to the patient in the table5610, then the record appears with a yellow background in the healthcarepractitioner's view until the patient views the comment. Suchcommunication between the healthcare practitioner and patient enhancesthe patient's compliance in the monitoring program and reflects the typeof communication between healthcare practitioner and patient that wouldoccur during an actual clinic visit.

The healthcare practitioner may also review the data presented in thetable 5610 of FIG. 56 that corresponds to the data of the patient'sblood sugar log 1510 of FIG. 15, by selecting the data presentationicons 5620-5626 above the table 5610.

The “Line Chart” icon 5620 allows the blood sugar log data to bepresented as a linear graph; the “Histograms” icon 5622 as histograms;the “Pie Chart” icon 5624 as a pie chart; and the “Multiple pie charts”icon 5626 as multiple pie charts, as described above and shown in FIGS.17-20

Selecting the healthcare practitioner “Message List” icon 5140 of FIG.51A changes the display to the healthcare practitioner message listscreen 7100 as shown in FIG. 71. The healthcare practitioner ispresented with a list of messages sent by the healthcare practitioner'spatients or by the healthcare practitioner, as shown in FIG. 71.Information, such as the date a message was sent, to whom the messagewas sent, who sent the message, and the subject/title of the message maybe presented. However, if the healthcare practitioner has selected aparticular patient to review that patient's records using one of thelist boxes 5020-5024, only those messages concerning that particularpatient are presented in a patient-specific healthcare message listscreen 7100, as shown in FIG. 73. Additionally, in various exemplaryembodiments, to distinguish unread from read messages, the unreadmessages in the list can be preceded by an asterisk, which can be colorcoded to increase its visibility.

When the healthcare practitioner selects one of the underlinedsubject/titles, the clinical management system retrieves the selectedmessage for the healthcare practitioner, as shown in FIG. 72. A messagescreen 7210 appears with information such as the date the message wassent, to whom the message is addressed, who sent the message, thesubject/title of the message and the message itself. If the entiremessage does not fit within the message screen 7210, horizontal and/orvertical scroll bars are presented for the healthcare practitioner toscroll through the message (not shown). At the end of the message thereis a “Reply” button 7220 and a “Close” button 7230. When selected, the“Reply” button 7220 allows the healthcare practitioner to send aresponse message to whomever sent the message. The “Close” button 7230allows the healthcare practitioner to exit the message list screen 7210and return the healthcare practitioner to the healthcare practitionermessage list screen 7100 of FIG. 73.

The healthcare practitioner may also create and add a new message usingthe healthcare practitioner message list screen 7100. The healthcarepractitioner can use this screen to create a message directed to anypatient that is assigned to that healthcare practitioner. The healthcarepractitioner selects a “Select a Patient” drop down list box 7110. The“Select a Patient” drop down list box 7110 provides a lists of thepatients in the clinical management system for chronic diseases 100assigned to that healthcare practitioner. The healthcare practitionerthen selects the patient that the healthcare practitioner wishes toaddress the message to using the list box 7110. However, if thehealthcare practitioner has already selected a particular patient usingone of the list boxes 5020-5024, the message is automatically addressedto that patient and the patient-specific healthcare practitioner messagelist screen 7100 is displayed, as shown in FIG. 73. The healthcarepractitioner does not need to provide this information. Accordingly, the“Select a Patient” drop down list box 7110 does not need to be shown inthe patient-specific healthcare practitioner message list screen 7100shown in FIGS. 73 and 74. The healthcare practitioner may also provide asubject/title for the message, but this is not required. The healthcarepractitioner does this by simply typing in the subject/title in the“Subject” data entry box 7120.

If the healthcare practitioner decides to discard the message, has madean error, or wants to change to whom the message is addressed to and/orthe subject/title of the message, the healthcare practitioner can selectthe “Reset” button 7130. When selected, the “Reset” button 7130 clearsto whom the message is addressed to as selected from the “Select aPatient” drop down list box 7110 and clears the “Subject” data entry box7120. The function of the “Reset” button 7130 can also be accomplishedby selecting a different individual from the “Select a Patient” dropdown list box 7110 for whom the message is addressed and by backspacingover the incorrect data entry and then typing the correct data in the“Subject” data entry box 7120.

After the healthcare practitioner has selected the patient to addressthe message and typed a subject/title for the message (optional), thehealthcare practitioner selects the “Add Message” button 7140. When thehealthcare practitioner selects the “Add Message” button 7140, thedisplay changes to the “Add a Message” screen, which is similar to thatshown in FIG. 70. The healthcare practitioner's “Add a Message” screendisplays the healthcare practitioner's name as who the message is from,the name of the patient to whom the message is addressed and thesubject/title, if provided by the healthcare practitioner. Additionally,there is a message data entry box 7010, a “Submit” button 7020, a“Reset” button 7030, and a “Cancel” button 7040. The healthcarepractitioner then enters his or her message into the message data entrybox 7010 by using the keyboard or some other data entry device. Oncefinished, the healthcare practitioner selects the “Submit” button 7020to send the message. If the healthcare practitioner is unsatisfied withthe inputted message and wishes to discard all of its contents, thehealthcare practitioner simply selects the “Reset” button 7030 orbackspaces over the undesired portions of the message. However, if thehealthcare practitioner wishes to disregard sending a message alltogether, the healthcare practitioner can select the “Cancel” button7040. This returns the healthcare practitioner to the healthcarepractitioner message list screen 7100 shown in FIGS. 71-74.

Selecting the “register patients or practitioners” icon 5033 of FIG. 50of the main practitioner data screen automatically changes the displayto that shown in FIG. 57. When the healthcare practitioner selects theunderlined “Practitioners” 5710 of FIG. 57, the display automaticallychanges to a “Practitioner Registration” form, as shown in FIG. 58. The“Practitioner Registration” form 5800 may include data entry input boxes5810 for the entry of, for example, enrollment date, last name, firstname, address, city, state, zip code, home and cell phones, pager, andc-mail or message address. The “Practitioner Registration” form 5800 mayalso include drop down list boxes 5820 for the entry of, for example,the healthcare practitioner's specialty and the occupation of thehealthcare practitioner, for example, healthcare practitioner, nurse,etc. The specialty and the occupation of the healthcare practitionerdictate which patients they will interact with through the system andtheir permissions, for example, viewing types of patient data, andprivileges, for example, entering new prescriptions for medications, onthe system.

When the healthcare practitioner selects the underlined “Patients” icon5720 shown in FIG. 57, the display automatically changes to a “PatientRegistration Form”, as shown in FIG. 59. The “Patient Registration Form”5900 may include data entry input boxes 5910 for the entry of, forexample, last name, first name, medical record number, address, city,state, zip code, home phone number, work phone number, cell phonenumber, e-mail or message address, emergency contact, relationship,address. phone number, date of birth, race, gender, educational level,and employment. The “Patient Registration Form” 5900 may also includedrop down list boxes 5920 for the entry of, for example, marital status,primary care healthcare practitioner, specialist, nurse, primarydisease, comorbidities, and allergies_Selecting the underlined phrasesof “Add Physician”, “Add Specialist”, and “Add Nurse” may allow thesehealthcare practitioners to be added to their respective drop down listboxes 5920 for entry into the “Patient Registration Form” 5900. Adialogue box 5930 may also be available to add comments. Selection of aspecialist dictates which healthcare practitioner and associatedhealthcare practitioners are responsible for the patient's care.

Selecting the “enter patient's lab results” icon 5034 of FIG. 50 of themain practitioner data screen 5000 automatically changes the display tothat shown in FIG. 60 for diabetic patients, and to that shown in FIG.61 for kidney disease patients. The “Lab Values Entry for DiabetesPatients” screen 6000 shown in FIG. 60 may include, for example, dropdown list boxes 6010, usable to enter the date for which the lab valuesare being entered, and usable to select the patient whose lab values arebeing entered. Additionally, the “Lab Values Entry for DiabetesPatients” display 6000 may include, for example, data entry input boxes6020, for the entry of tab values, such as, HbAIC, cholesterol, HDL,LDL, triglyceride and urine microalbumin, as described above in relationto the patient's “Lab Results” table 2110 shown in FIG. 21.

In the “Lab Values Entry for Dialysis Patients” screen 6100 shown inFIG. 61, the healthcare practitioner may also enter the date for whichthe lab values are being entered using, for example, drop down listboxes 6110, and may select the patient whose lab values are beingentered using, for example, a drop down list box 6120. Additionally, afirst option button 6130 indicates that no hospitalization is requiredfor the test and a second option button 6134 indicates thathospitalization is required for the test. After selecting the “Go”button 6138, the screen changes to display the continued “Lab ValuesEntry for Dialysis Patients” screen 6200.

As shown in FIG. 62, the “Lab Values Entry for Dialysis Patients” screen6200 shows, for example, multiple data entry input boxes 6210, by whichlaboratory test results may be entered by the healthcare practitioner.The entered laboratory test results may include but are not limited to,for example, Kt/V, albumin, calcium, creatinine, ferritin, glucose,HGB×3, iron, phosphate, potassium, PTH, TIBC, TSH, T3 uptake. T4 total,T7/Ffl, cholesterol—FIDL, LDL, triglycerides, HBSAG, HBSAB, HEPCAB, andHgbA1C. The entered laboratory results are then displayed to the kidneydisease patient in the “Lab Results” table 3610, discussed above andshown in FIG. 36.

Selecting the “patient reminders” icon 5035 of FIG. 50 of the mainpractitioner data screen 5000 automatically changes to that shown inFIG. 63 for diabetic patients, and to that shown in FIG. 64 for kidneydisease patients.

The “Patient Reminders” screen 6300 shown in FIG. 63 for the diabeticpatient may include the current date and data which is to be entered bythe healthcare practitioner including, but not limited to, for example,the selected patient, the date of the patient's visit and when the nextvisit is scheduled, the date of requested lab work and when the next labwork is scheduled, the date of requested HbAlC test values and when thenext HbAlC test is scheduled, the date of a foot exam and the nextscheduled foot exam, the date of an eye exam and the next scheduled eyeexam. Selecting the patient and entering scheduled dates for visits,tests and exams may be facilitated by, for example, drop down list boxes6310 that provide selections for the month, date and year, as shown inFIG. 63. Selecting the next scheduled date for visits, tests and examsmay be facilitated by, for example, option buttons 6340 or data entryinput boxes 6320, as also shown in FIG. 63. The entered patientreminders are displayed to the patient in the main patient data screenfor diabetic patients 700, as described above and shown in FIG. 10.

The “Patient Reminders” screen 6400 shown in FIG. 64 for the kidneydisease patient may include the current date and, for example, a dropdown list box 6410 for selecting the patient to whom the reminder is tobe addressed. After selecting a patient, the main practitioner datascreen changes to that shown in FIG. 65. The continued “PatientReminders” screen 6500 shown in FIG. 65 may include the current date andthe selected patient's name, and a number of, for example, drop downlist boxes 6510, that facilitate entries of month, date and year forvarious reminders. The reminder dates that are entered for the kidneydisease patient may include, but are not limited to a clinic visit, Kt/Vtest, lab work, chest X-ray, EKG, PPD/TB risk appraisal, a home visit,gynecology/mammogram exam, patient continuing education, medical historyand physical, nursing assessment, long term care plan/conference, shortterm care plan/conference, and transfer set change. The entered patientreminders are displayed to the patient in the main patient data screen3200 for kidney disease patients, as described above but not shown inFIG. 32.

Selecting the “On-line chatroom” icon 5036 of FIG. 50 of the mainpractitioner data screen 5000 automatically changes the screen to thatof a message dialogue box (not shown) including the e-mail or messageaddress of the patient support group for the particular chronic illnessthat the healthcare practitioner is managing. The healthcarepractitioner may then interact with the patient support group, offeringsuggestions for daily living, explaining medical procedures, correctingmisunderstandings, etc.

When a visitor logs on to the system, he or she may enter the cliniclobby 400 of FIG. 4 and proceed to open the door icon 404 of the publiclibrary, as shown in FIG. 5. Selecting the door icon 404 changes thescreen to that of the main visitor data screen 6600, as shown in FIG.66. The main visitor data screen 6600 includes, for example, a frame6602 along its upper and left-side borders that has a light greenbackground 810 and a central display area 6610.

The upper border of the frame 6602 may include the name of the projectand an icon 6640 that, when selected, connects the visitor to anotherscreen (not shown) that is accessible to visitors. The left side of theborder of the frame 6602 may include, for example, icons for“Description” 6630, “Diabetes” 6631, “Kidney Disease” 6632, “News Items”6633, “Public” 6634, and “Main Page” 6635. The central display area 6610may include the latest news items concerning the chronic illnesses thatthe clinic manages. For example, if the underlined “Diabetes News” 6620is selected, the screen will change to display the latest diabetes newsin the central display area 6610, corresponding to that news displayedin the patient's education site, as shown in FIG. 13. The visitor mayalso select archival news by selecting the archival article from, forexample, a drop down list box 6625, labeled “Diabetes Archive”. Thevisitor may similarly access the latest news item and archival newsitems by selecting the underlined “Kidney Disease News” 6630 or the dropdown list box 6635, labeled “Kidney Disease Archive”.

Selecting the “Description” icon 6630 of FIG. 66 changes the screen todisplay a project description screen 6700, as shown in FIGS. 67A-67G.The project description may include multiple pictures 6705 which aresequentially displayed while the project description is displayed. Theproject description may also include links to other sites within theclinic system 200, Internet sites or World Wide Web sites for furtherdescription of the project.

Selecting the “Diabetes” icon 6631 of FIG. 66 changes the screen todisplay the diabetes education site, as described above and shown inFIG. 29

Selecting the “Kidney Disease” icon 6632 of FIG. 66 changes the screento display the PD education information, as described above and shown inFIG. 38.

Selecting the “News Item” icon 6633 changes the screen to display themain visitor data screen 6600 of FIG. 66.

By selecting the “Main Page” icon 6635 of FIG. 66, the visitor returnsto the clinic lobby 400 of FIG. 4.

While this invention has been described in conjunction with the specificembodiments outlined above, it is evident that many alternatives,modifications and variations will be apparent to those skilled in theart. Accordingly, the preferred embodiments of the invention, as setforth above, are intended to be illustrative, not limiting. Variouschanges may be made without departing from the spirit and the scope ofthe invention.

1-64. (canceled)
 65. A method for simulating, for a user having at leastone chronic illness, a visit to a chronic illness management clinic,comprising: displaying a first set of a plurality of graphical userinterface screens, comprising at least one of: displaying a first subsetof at least one graphical user interface screen usable by the user toinput or review clinical data obtained from the user usable to manage atleast one of the user's at least one chronic illness, the clinical databeing stored in the database, and displaying a second subset of at leastone graphical user interface screen usable by the user to accessmanagement information usable to manage at least one of the user's atleast one chronic illness, the management information derived from theclinical data obtained from the user and stored in the database; anddisplaying a second set of graphical user interface screens thatgraphically depict a clinic that the user would visit to manage, supplyor review the management information and the clinical data for at leastone of the at least one chronic illness, the second set of graphicaluser interface screens simulating an interaction of the user with theclinic, wherein the first set of graphical user interface screens areaccessible through the second set of graphical user interface screens.66. The method of claim 65, wherein displaying the first set ofgraphical user interface screens comprises: displaying, in each of thefirst set of graphical user interface screens, a frame portion thatincludes a plurality of selectable icons; and displaying, in each of thefirst set of graphical user interface screens, at least one of at leastdata and information in a central data area that is bracketed by theframe portion.
 67. The method of claim 66, wherein displaying the frameportion comprises displaying at least some of at least a messages icon,a clinical data icon, an educational information icon, a contacts icon,a logout icon, a sponsor icon, and a patient information icon in theframe portion.
 68. The method of claim 67, further comprising selectingthe messages icon, wherein displaying at least one of at least data andinformation in the central data area comprises displaying a messagesscreen in the central data area in response to the messages icon beingselected.
 69. The method of claim 68, wherein displaying the messagesscreen in the central data area comprises at least some of: displayingan alerts portion that includes a first set of information derived fromthe clinical data to the user; displaying a messages portion thatincludes a second set of information derived from the clinical data tothe user; and displaying a reminders portion that includes reminderinformation regarding management of at least one of the user's at leastone chronic illness.
 70. The method of claim 69, further comprising:retrieving, as at least a portion of the first set of information,critical information regarding management of one of the user's at leastone chronic illness derived from the clinical data stored in thedatabase; and displaying, as at least a portion of the first set ofinformation, the critical information in the alerts portion.
 71. Themethod of claim 70, wherein displaying at least the critical informationin the alerts portion comprises at least some of at least: displayinginformation regarding missing critical data; and displaying informationregarding clinical data parameters that have values outside of definedranges for the user.
 72. The method of claim 69, further comprising:displaying at least one selectable icon embedded in the first set ofinformation displayed in the alerts portion, each at least oneselectable icon being associated with a portion of the first set ofinformation; and displaying to the user, in response to one of the atleast one selectable icon embedded in the first set of information beingselected, additional information associated with the associated portionof the first set of information for that selected embedded selectableicon.
 73. The method of claim 72, wherein displaying the additionalinformation to the user comprises displaying the additional informationin the central data area in place of the messages screen.
 74. The methodof claim 72, wherein displaying the additional information comprisesdisplaying the additional information in a separate window displayedover the messages screen.
 75. The method of claim 69, furthercomprising: retrieving, as at least a portion of the second set ofinformation, non-critical information regarding management of one of theuser's at least one chronic illness derived from the clinical datastored in the database; and displaying, as at least a portion of thesecond set of information, the non-critical information in the messagesportion.
 76. The method of claim 75, wherein displaying the non-criticalinformation comprises at least some of at least: displaying informationregarding values of clinical data parameters of clinical data suppliedby the user; displaying information regarding values of clinical dataparameters of other clinical data; and displaying indications of qualityof management of the displayed clinical data parameters based on thedisplayed values.
 77. The method of claim 69, further comprising:displaying at least one selectable icon embedded in the second set ofinformation displayed in the messages portion, each at least oneselectable icon being associated with a portion of the second set ofinformation; and displaying to the user, in response to one of the atleast one selectable icon embedded in the second set of informationbeing selected, additional information associated with the associatedportion of the second set of information for that selected embeddedselectable icon.
 78. The method of claim 77, wherein displaying theadditional information associated with the associated portion of thesecond set of information for that selected embedded selectable iconcomprises displaying the additional information in the central data areain place of the messages screen.
 79. The method of claim 77, whereindisplaying the additional information associated with the associatedportion of the second set of information for that selected embeddedselectable icon comprises displaying the additional information in aseparate window displayed over the messages screen.
 80. The method ofclaim 69, wherein displaying the reminder information in the remindersportion comprises at least some of: displaying at least one upcomingoffice visit appointment; displaying at least one upcoming examinationappointment; displaying at least one overdue office visit appointment;and displaying at least one overdue examination appointment.
 81. Themethod of claim 68, wherein displaying the messages screen in thecentral data area in response to the messages icon being selectedcomprises displaying the messages screen in place of acurrently-displayed graphical user interface screen of the first set ofgraphical user interface screens.
 82. The method of claim 67, furthercomprising selecting the clinical data icon, wherein displaying at leastone of at least data and information in the central data area comprisesdisplaying the first subset of at least one graphical user interfaces inresponse to the clinical data icon being selected.
 83. The method ofclaim 82, wherein: the first subset of graphical user interfacescomprises at least some of at least one user supplied clinical datadisplay screen, a laboratory test clinical data display screen, amedications data display screen, a blood pressure data display screen,an exercise data display screen, a data summary screen, and a messageslist display screen; and displaying the first subset of graphical userinterface screens comprises displaying, in each of the first subset ofgraphical user interface screens displayed in the central data portion,a second plurality of selectable icons, each selectable icon of thesecond plurality of selectable icons associated with one of the firstsubset of graphical user interface screens.
 84. The method of claim 83,wherein displaying the first subset of at least one graphical userinterfaces in response to the clinical data icon being selectedcomprises displaying, in response to the clinical data icon beingselected, a predetermined one of the at least one user supplied clinicaldata display screen, the laboratory test clinical data display screen,the medications data display screen, the blood pressure data displayscreen, the exercise data display screen, a data summary screen, and amessages list display screen in the central data area. 85-129.(canceled)